Cases reported "Cardiovascular Diseases"

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1/22. Cardiovascular consequences of renal anaemia and erythropoietin therapy.

    Cardiovascular disease is the leading cause of increased mortality in patients with renal failure and vigorous attention to cardiovascular risk factors is therefore required to improve patient outcome. The availability of recombinant human Epo has focused the interest on the role of chronic anaemia in the pathogenesis of cardiovascular disease. Severalfold evidence indicates that anaemia can contribute to cardiac volume overload and together with overhydration, fistula flow and the pressure overload secondary to arterial hypertension, it may play a significant role in the development of cardiac hypertrophy. As in the general population left ventricular hypertrophy is a severe adverse risk factor in renal patients. In addition, in the presence of ischaemic heart disease anaemia may further worsen cardiac oxygen supply. This dual effect of anaemia probably explains why epidemiological studies have shown that a 1 g/dl decrease in haemoglobin levels is an independent, statistically significant risk factor for the development of cardiac morbidity and mortality. Follow-up examinations have demonstrated that partial correction of anaemia with recombinant Epo can improve cardiac oxygen supply and partially reverse pathological changes in left ventricular geometry. However, although partial anaemia correction regularly reduces left ventricular volume, the effects on wall thickness are far less significant. Moreover, in patients with advanced cardiac disease it has recently not been possible to demonstrate that a normalization of haemoglobin levels provides further benefit. It is not unlikely therefore that the development of severe anaemia has to be prevented by early implementation of Epo therapy in order to achieve the maximum benefit with respect to the cardiovascular system.
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2/22. Impairment rating of the cardiovascular system: Idiopathic cardiomyopathy.

    disease of the cardiovascular system is the leading cause of morbidity and mortality among the adult population in the united states. physicians performing impairment ratings attributable to cardiovascular disease are required to correlate the extent of the disease and its impact on a person's daily activities. A person's final impairment determination may vary based on the specific guidelines used (american medical association Guides to the Evaluation for Permanent Impairment, social security, State Worker Compensation requirements, etc.), the version of the guidelines (year, edition), and each guide's specific criteria. The examiner needs to know which rating system to use, the system's criteria, critical definitions, and potential limitations.
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3/22. mortality in pediatric epilepsy.

    mortality in pediatric epilepsy is the subject of this review. epilepsy in both adults and children increases the risk of premature death. Conditions that are comorbid with epilepsy may carry an increased mortality risk. patients with neurologic compromise may be at risk for aspiration and critical respiratory disease. epilepsy per se enhances the risks of accidents, particularly drowning. epilepsy may result in unwitnessed or, less frequently, witnessed sudden death. Witnessed sudden death frequently involves an observed seizure. Cardiac and respiratory mechanisms for epileptic sudden death have been proposed. Reducing the number of seizures should reduce the risk for sudden death. awareness of the increased risk for premature death associated with epilepsy may enhance patients' and parents' cooperation with therapy.
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4/22. The impact of Thought Field Therapy on heart rate variability.

    Thought Field Therapy (TFT) is a rapid treatment for psychological problems typically taking only minutes. HRV has been shown to be a strong predictor of mortality and is adversely affected by such problems as anxiety, depression, and trauma. Interventions presented in the current literature show modest improvements in HRV. Twenty cases, treated by the author and other therapists with TFT, are presented. The cases include some with diagnosed heart problems and very low HRV, which is ordinarily more resistant to change. The degree of improvements that are registered on HRV as a result of TFT treatment exceeds reports found in the current literature. There is a close correspondence between improved HRV and client report of reduced degree of upset. HRV may prove to be an appropriate objective measure of psychotherapy efficacy given the correspondence between client report and HRV outcome. Further research in TFT and HRV is encouraged by these results.
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5/22. Toxicity of over-the-counter cough and cold medications.

    Over-the-counter (OTC) cough and cold medications are marketed widely for relief of common cold symptoms, and yet studies have failed to demonstrate a benefit of these medications for young children. In addition, OTC medications can be associated with significant morbidity and even mortality in both acute overdoses and when administered in correct doses for chronic periods of time. physicians often do not inquire about OTC medication use, and parents (or other caregivers) often do not perceive OTCs as medications. We present 3 cases of adverse outcomes over a 13-month period-including 1 death-as a result of OTC cough and cold medication use. We explore the toxicities of OTC cough and cold medications, discuss mechanisms of dosing errors, and suggest why physicians should be more vigilant in specifically inquiring about OTCs when evaluating an ill child.
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6/22. Cardiovascular manifestations in marfan syndrome.

    INTRODUCTION: Cardiovascular complications are the major cause of morbidity and mortality in marfan syndrome (MS), a common connective tissue disorder. Currently it is considered that the prognosis and morphologic characteristics in infantile marfan syndrome may be quite different from those reported in older patients. The objective of this study was to analyze the cardiovascular manifestations and evolution of the patients with marfan syndrome followed at our pediatric cardiac unit. methods: The authors reviewed the clinical files of all the patients that fulfilled the diagnostic criteria for MS according to De Paepe et al. (1996). We analyzed the following parameters: gender, age at referral, race, family history, clinical examination, diagnostic exams, therapy and evolution. The patients were divided into two groups according to the age at diagnosis: infants (group 1) and older patients (group 2). RESULTS: Group 1 included 3 infants, two boys and one girl, sporadic cases, presenting congestive heart failure. The major cardiac diagnoses were aortic dilatation (1/3) and mitral valve prolapse with severe mitral regurgitation (2/3). Congenital heart disease was associated in two cases (patent ductus arteriosus and atrial septal defect). Two needed cardiac surgery at an early age and one was recently proposed for surgery. There were no deaths. Group 2 included 20 patients, 14 boys and 6 girls, first seen at a mean age of 8 years. Ten had a positive family history and none presented cardiac symptoms. The major cardiac manifestations were mitral valve prolapse (18/20) and aortic dilatation (17/20). There was no significant progression of the cardiac lesions, except for one case, during the 12 years of follow-up. CONCLUSION: Infantile MS presented high morbidity; mitral regurgitation was severe in two cases. All patients presented heart failure, two needing early operations. In classic MS evolution was favorable, and the commonest cardiac lesions were mitral valve prolapse and aortic dilatation. We emphasize the need for beta-blockers to prevent progression of aortic dilatation. The decision for surgery rests upon the severity of valve regurgitation and the rate of progression of aortic dilatation. It is important to inform patients and family about physical exercise, prevention of endocarditis, risks associated with pregnancy and genetic counseling.
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7/22. beta-Blockers and reduction of cardiac events in noncardiac surgery: clinical applications.

    Recent studies suggest that beta-blockers administered perioperatively may reduce the risk of adverse cardiac events and mortality in patients who have cardiac risk factors and undergo major noncardiac surgery. The objective of this article is to provide practicing physicians with examples of perioperative beta-blocker use in practice by using several hypothetical cases. Although current evidence describing the effectiveness of perioperative beta-blockade may not address all possible clinical situations, it is possible to formulate an evidence-based approach that will maximize benefit to patients. We describe how information from several sources can be used to guide management of patients with limited exercise tolerance, those at highest risk for perioperative cardiac events, patients who are taking beta-blockers long-term, and those with relative contraindications to beta-blockade. Even though fine points of their use remain to be elucidated, perioperative beta-blocker use is important and can be easily applied in practice by any physician involved with the care of patients perioperatively.
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8/22. Hemoglobin levels, cardiovascular disease, and left ventricular hypertrophy in patients with chronic kidney disease. Case study of the anemic patient.

    Cardiovascular disease is the primary cause of morbidity and mortality in patients with chronic kidney disease. anemia, a well-defined risk factor for cardiovascular disease, has been shown to contribute to the development of angina pectoris, ischemic events, and left ventricular hypertrophy. Data indicate that these cardiovascular-related disorders are often ameliorated or reversed in patients who maintain hemoglobin (Hb) levels in the 11 to 12 g/dL range recommended by NKF-K/DOQI. Conversely, Hb levels below 11 g/dL result in an increase in cardiovascular disorders and a 2.9-fold increased risk of death. nephrology nurses should understand the interplay between Hb levels and cardiovascular disease, and how their efforts to maintain Hb levels > or = 11 g/dL can positively affect patient outcomes.
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9/22. obesity and the metabolic syndrome.

    The prevalence of marked obesity is increasing rapidly among adults and has more than doubled in 10 years. Sixty-one percent of the adult population of the united states is overweight or obese. Americans are the fattest people on earth. Paradoxically these increases in the numbers of persons who are obese or overweight have occurred during recent years when Americans have been preoccupied with numerous dietary programs, diet products, weight control, health clubs, home exercise equipment, and physical fitness videos, each "guaranteed" to bring rapid results. overweight and obesity are also world problems. The world health organization estimates that 1 billion people around the world are now overweight or obese. Westernization of diets has been part of the problem. Fruits, vegetables, and whole grains are being replaced by readily accessible foods high in saturated fat, sugar, and refined carbohydrates. Since class 3 obesity (morbid or extreme obesity) is associated with the most severe health complications, the incidence of hypertension, stroke, heart disease, diabetes, and peripheral vascular disease will increase substantially in the future. Recently, obesity alone has been implicated in the development of cardiac hypertrophy and CHF. The metabolic syndrome associated with abdominal obesity, which includes insulin resistance, dyslipidemia, and elevated CRP levels, identifies subjects who have an increase in cardiovascular morbidity and mortality. Twenty to 25% of the adult population in the united states have the metabolic syndrome, and in some older groups this prevalence approaches 50%. The prevalence of overweight children in the united states has also been increasing dramatically, especially among non-Hispanic blacks and Mexican-American adolescents. overweight children usually become overweight adults. atherosclerosis begins in childhood. The degree of atherosclerotic changes in children and young adults can be correlated with the presence of the same risk factors seen in adults. As health providers, our direction is obvious!
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10/22. Predicted survival in peptic ulcer patients based on computer analysis of preoperative variables.

    A prospective study designed to emphasize and quantitate the operative risk of patients preparing to undergo surgery for the treatment of complicated peptic ulcer disease is presented. Data were gathered from 347 consecutive patients operated on with benign gastric and/or duodenal ulcers in a veterans Hospital over an 8-year period. Resident surgeons performed all operations and for the most part decided on the operative procedure used, with advice from attending faculty. Preoperative factors influencing the operative mortality in 34 patients were compared with those in surviving patients and subjected to a multivariant discriminant function analysis by computer. Ten variables were identified as being significantly different (P less than 0.05-P less than 0.01) between the survivor and non-survivor groups. Using the discriminant weights of these variables, a computer program was written to calculate the 30-day operative mortality of any preoperative patient based on this past experience. The accuracy of the program is excellent in good risk patients; i.e., a predicted greater than 90% chance of survival was correct 98.9% of the time with 3 deaths in 279 patients. patients at the low end of the scale (less than 10%) were predicted with 85% accuracy. In the last 8 months, 29 patients have undergone surgery after prospective computer assessment of their operativ risk. All have survived with a predicted chance of greater than 50%. Four patients died with survival chances predicted at 4, 2, 1, and 1%. The computer may be used as an educational vehicle for sharpening our preoperative assessment of a patient with ulcer disease, particularly regarding operative risk.
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