Showing posts with label Cardiology. Show all posts
Showing posts with label Cardiology. Show all posts
Monday, October 10, 2011
Who should receive a cardiac CT?
Thursday, September 15, 2011
Coronary CT and Calcium scoring
Coronary CT and Calcium scoring
Application of Coronary Calcium in Symptomatic Individuals
The presence or absence of coronary calcium can significantly alter the posterior probability of CAD for individuals presenting with chest pain. The calculator below shows how these probabilities are affected and computes similar data for exercise treadmill testing. Note that coronary calcium compares favorably with exercise testing for evaluation of chest pain syndromes and often has a higher negative predictive value, especially in women were exercise treadmill testing is known to be weak.
Friday, October 1, 2010
n-3 Fatty Acids and Cardiovascular Events after Myocardial infarction
CONCLUSIONS
Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy. (Funded by the Netherlands Heart Foundation and others; ClinicalTrials.gov number, NCT00127452.)
2010, NEJM
Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy. (Funded by the Netherlands Heart Foundation and others; ClinicalTrials.gov number, NCT00127452.)
2010, NEJM
Thursday, September 16, 2010
Tuesday, July 6, 2010
Rate Versus Rhythm Control in the Management of Atrial Fibrillation, AHA
Conclusion
The bottom line is that rate control is at least as good as rhythm control strategy. A non-statistically significant increase in stroke is seen in the rhythm control group. No difference is seen in quality of life. The results of the AFFIRM trial and other clinical trials studying rate versus rhythm control are going to significantly change the way we treat AF. There is now much less push to try to convert a patient into sinus rhythm unless the patient is very symptomatic or rate control is difficult. However, it is important not to stop the anticoagulation. As far as antiarrhythmic drugs are concerned, it’s not always necessary to change the therapy every time a patient has an occurrence. If the patient is controlled, not symptomatic and on anticoagulation, they may not have to have their therapy changed.
The new strategy for AF based on the latest information is:
A Fib--> control rate and anticoagulate --> if patient's rate is controlled and symptom free, OK to leave in atrial fibrillation.
--> if still symptomatic, unable to control rate or other confounding reasons sinus rhythm is preferred
--> cardiovert (TEE guided to rule out clot or anti-coagulate x 4 weeks)
--> referral for experienced electrophysiologist if considering ablation for a fib (best candidates: young patients + a fib initiated by premature atrial complex who have failed drug therapy)
*This link is provided for convenience only, and is not an endorsement or assurance of the entity or any product or service.
This content is reviewed regularly. Last updated 12/5/08.
Full text, AHA, 2010
The bottom line is that rate control is at least as good as rhythm control strategy. A non-statistically significant increase in stroke is seen in the rhythm control group. No difference is seen in quality of life. The results of the AFFIRM trial and other clinical trials studying rate versus rhythm control are going to significantly change the way we treat AF. There is now much less push to try to convert a patient into sinus rhythm unless the patient is very symptomatic or rate control is difficult. However, it is important not to stop the anticoagulation. As far as antiarrhythmic drugs are concerned, it’s not always necessary to change the therapy every time a patient has an occurrence. If the patient is controlled, not symptomatic and on anticoagulation, they may not have to have their therapy changed.
The new strategy for AF based on the latest information is:
A Fib--> control rate and anticoagulate --> if patient's rate is controlled and symptom free, OK to leave in atrial fibrillation.
--> if still symptomatic, unable to control rate or other confounding reasons sinus rhythm is preferred
--> cardiovert (TEE guided to rule out clot or anti-coagulate x 4 weeks)
--> referral for experienced electrophysiologist if considering ablation for a fib (best candidates: young patients + a fib initiated by premature atrial complex who have failed drug therapy)
*This link is provided for convenience only, and is not an endorsement or assurance of the entity or any product or service.
This content is reviewed regularly. Last updated 12/5/08.
Full text, AHA, 2010
Thursday, March 25, 2010
Hostile Behaviors Predict Cardiovascular Mortality Among Men Enrolled in the Multiple Risk Factor Intervention Trial, 2004 Circulation
Background—Hostility is associated with incident coronary disease in most large population-based studies, but little is known about its association with cardiovascular disease (CVD) mortality in high-risk individuals. The aim of this study was to assess the association of hostility with CVD mortality in the subsequent 16 years in the Multiple Risk Factor Intervention Trial (MRFIT) participants and to explore the influence of hostility in the subset that had a nonfatal CVD event during the trial.
Methods and Results—We coded the Structured Interview responses of 259 men who died of CVD during the 16 years of follow-up and 259 matching living control subjects. Signs of hostility were assessed by use of the Interpersonal Hostility Assessment Technique. Matching was based on center, intervention group, age, race, and interviewer; covariates included study entry diastolic blood pressure, cholesterol, smoking status, and nonfatal CVD event during the trial. High-hostile men were more likely to die of CVD than were low-hostile men. Adjusted odds ratio (OR) and 95% confidence intervals (CIs) were 1.61, 1.09 to 2.39. After the trial, high -hostile men who also had a nonfatal event during the trial were particularly likely to die of CVD, OR, 5.06, 1.42 to 8.22, compared with low-hostile men without a nonfatal event during the trial.
Conclusions—Hostility may be a risk factor for CVD mortality among high-risk men. Interventions aimed at anger management and stress reduction along with risk factor modification may be useful for hostile patients.
Authorized only
Methods and Results—We coded the Structured Interview responses of 259 men who died of CVD during the 16 years of follow-up and 259 matching living control subjects. Signs of hostility were assessed by use of the Interpersonal Hostility Assessment Technique. Matching was based on center, intervention group, age, race, and interviewer; covariates included study entry diastolic blood pressure, cholesterol, smoking status, and nonfatal CVD event during the trial. High-hostile men were more likely to die of CVD than were low-hostile men. Adjusted odds ratio (OR) and 95% confidence intervals (CIs) were 1.61, 1.09 to 2.39. After the trial, high -hostile men who also had a nonfatal event during the trial were particularly likely to die of CVD, OR, 5.06, 1.42 to 8.22, compared with low-hostile men without a nonfatal event during the trial.
Conclusions—Hostility may be a risk factor for CVD mortality among high-risk men. Interventions aimed at anger management and stress reduction along with risk factor modification may be useful for hostile patients.
Authorized only
Does Anxiety Increase Risk Of Cardiovascular Disease?
Science Daily, Nov. 16, 2008
Ref)
Association between Anxiety and Factors of Coagulation and Fibrinolysis, 2008 Psychotherapy and Psychosomatics
Background: Psychological stress and anxiety have been shown to produce an activation of coagulation and fibrinolysis. Resulting hypercoagulability is a risk factor for cardiovascular diseases, and could therefore contribute to an increased
prevalence of coronary artery disease in anxiety patients. However, hemostasis function has not yet been studied in patients with clinically relevant anxiety disorders.
Methods: A group of anxiety patients (panic disorder with agoraphobia or social phobia) and a healthy control group (each n = 29) completed some questionnaires [SCL-K9 (a short form of the SCL-90-R), State Trait Anxiety Inventory,
ADS (general depression scale)], and had blood drawn after a 15-min rest period. To assess the reaction of the hemostatic system by global entities, sum scores were computed from parameters of coagulation and fibrinolysis (fibrinogen, FVII,
FVIII, vWF, F1 + 2, TAT, D -dimer, 2 -AP, PAP, tPA, PAI-1). Interfering variables, such as age, gender, alcohol consumption and smoking status, were controlled.
Results: Anxiety patients scored higher in a composite hemostatic score and a sum score of fibrinolysis in comparison to the control group, with a predominant activation of inhibitors in fibrinolysis. However, the psychological variable with the closest association to hemostasis was not trait anxiety, but self-perceived worry about blood drawing before blood sampling was performed.
Conclusions: The coagulation and fibrinolysis system is activated in the direction of a hypercoagulable state in patients with severe phobic anxiety, triggered by
fear of blood drawing. This could be one mediating factor for the increased risk of cardiovascular diseases in this population. Acute situational phobic anxiety should be monitored closely when studying the association between anxiety and
hemostasis.
Authorized only
Ref)
Association between Anxiety and Factors of Coagulation and Fibrinolysis, 2008 Psychotherapy and Psychosomatics
Background: Psychological stress and anxiety have been shown to produce an activation of coagulation and fibrinolysis. Resulting hypercoagulability is a risk factor for cardiovascular diseases, and could therefore contribute to an increased
prevalence of coronary artery disease in anxiety patients. However, hemostasis function has not yet been studied in patients with clinically relevant anxiety disorders.
Methods: A group of anxiety patients (panic disorder with agoraphobia or social phobia) and a healthy control group (each n = 29) completed some questionnaires [SCL-K9 (a short form of the SCL-90-R), State Trait Anxiety Inventory,
ADS (general depression scale)], and had blood drawn after a 15-min rest period. To assess the reaction of the hemostatic system by global entities, sum scores were computed from parameters of coagulation and fibrinolysis (fibrinogen, FVII,
FVIII, vWF, F1 + 2, TAT, D -dimer, 2 -AP, PAP, tPA, PAI-1). Interfering variables, such as age, gender, alcohol consumption and smoking status, were controlled.
Results: Anxiety patients scored higher in a composite hemostatic score and a sum score of fibrinolysis in comparison to the control group, with a predominant activation of inhibitors in fibrinolysis. However, the psychological variable with the closest association to hemostasis was not trait anxiety, but self-perceived worry about blood drawing before blood sampling was performed.
Conclusions: The coagulation and fibrinolysis system is activated in the direction of a hypercoagulable state in patients with severe phobic anxiety, triggered by
fear of blood drawing. This could be one mediating factor for the increased risk of cardiovascular diseases in this population. Acute situational phobic anxiety should be monitored closely when studying the association between anxiety and
hemostasis.
Authorized only
Friday, February 19, 2010
Genetic risk scores don’t predict CVD, Feb. 2010 The Doctor's Channel
....Contrary to expectations, individual genetic markers don’t add up to a genetic risk score that’s any better than traditional risk factors for predicting cardiovascular disease, researchers are reporting....
Genetic risk scores don’t predict CVD, Feb. 2010 The Doctor's Channel
Genetic risk scores don’t predict CVD, Feb. 2010 The Doctor's Channel
Saturday, December 19, 2009
Friday, December 18, 2009
Diagnosis and Management of the Metabolic Syndrome
An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement
Metabolic Syndrome (Full Text)
Metabolic Syndrome (Full Text)
Wednesday, December 16, 2009
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