Point-of-care ultrasound of echocardiographic is capable of identifying the precise causes of hemodynamic disorder in patients with sepsis especially septic shock [1]. Patients in sepsis demonstrate complex alterations in their circulation, including changes in preload and afterload and right ventricle dysfunction [2]. Based on systemic inflammation it can also cause a significant proportion of acute lung injury, as the most common manifestation of sepsis with multiple organ dysfunction [3], real-time bedside assessment of lung function is required, simple using of cardiac ultrasound may lead to the omission of clinical information.
Background: Dilated Cardiomyopathy (DCM) is the second most important cause of heart failure in Tanzania, and is associated with high mortality. Arrhythmias and/or conduction abnormalities contribute to sudden cardiac death, which occurs in up to 50% of DCM patients. Data on the burden and associated factors of rhythm and conduction abnormalities in DCM patients may help to prepare local treatment protocols.
Background: Hyperlipidemia is a condition in which blood lipid levels are greater than the normal range, and it is a major risk factor for the development of cardiac heart diseases. It affects 25-30% of the urban and 15-20% of the rural population. The current hyperlipidemia classification schemes and treatment levels are based on the Adult Treatment Program-3 guidelines issued by the National Cholesterol Education Panel, but there is no permanent treatment. So, the present study was aimed to investigate the antihyperlipidemic effect of Edaravone in Triton-X 100 and High Fat Diet-induced hyperlipidemic rat models.
Background: To retrospectively evaluate Doppler ultrasound findings for patients with Popliteal Vascular Entrapment Syndrome (PVES).
Background: To retrospectively evaluate Doppler ultrasound findings for patients with Popliteal Vascular Entrapment Syndrome (PVES).
Diet is one of the mosaics of environmental factors that can affect heart health. This impact, positive or negative, could occur through left ventricular remodeling.
It is clear from the results that the classification, using these defining variables, of having the metabolic syndrome is less than 10% better than chance (50/50). The number of false positive selections is about three times as great as the true positives which account for only 58% of the actual positive cases. The amount of total variance accounted for by these defining variables ranges between 23% to 34%. When four definers ABCD were used together the results were only marginally better. This weak relationship between MI and defining variables demonstrates that the metabolic syndrome is a very imperfect concept. In its present form its use is likely to give misleading conclusions. Thanks to Professor Y. Ben-Shlomo for access to the Caerphilly data. Assumptions underlying the concept of the Metabolic Syndrome (MS) are implicit rather than explicit. Categorization of patients into have and don’t have MS groups is based on five features, any combination of three or more may be used to determine which category they belong to. These features are triglyceride, glucose, and High Density (HD) cholesterol levels, blood pressure and obesity.
Introduction: Early Mobilization (EM) of patients in Intensive Care Unit (ICU) has received considerable attention in scientific literature over the past several years. It has been reported that EM decrease Hospital Length of Stay (LOS).
Background and aim: Familial HCM gene mutation carriers without overt left ventricular hypertrophy (gene positive/phenotype negative G+/P-) can harbor subclinical changes in cardiovascular structure and function that precede the development of Hypertrophic Cardiomyopathy (HCM). Conventional echocardiography parameter ejection fraction is normal in HCM patients. We sought to investigate whether Velocity Vector Imaging (VVI) and NT-proBNP are more sensitive to evaluate heart function.
Tacrolimus is a broadly used immunosuppressive agent in organ transplanted patients. It is known that it may induce arrhythmias. We here report on a heart transplanted patient with supraventricular and ventricular arrhythmias with an elevated tacrolimus trough serum level due to severe diarrhea.
In this brief review of the recent evolution of the pharmacological treatment of Type 2 Diabetes Mellitus (T2DM), we will analyze how different ways of living with diabetes coexist around the world. To define them, we will use the concept that we have called the three contemporary visions of T2DM, namely: dark vision, luminous vision, and bright vision. We will also discuss how the glucocentric paradigm of T2DM treatment led to the development, implementation, and publication of the Cardiovascular Outcomes Trials (CVOTs) in T2DM. Since June 2013, eighteen CVOTs have been published that have studied the cardiovascular safety of fifteen anti-diabetic drugs belonging to four new therapeutic classes. Together, these studies have included more than 150,000 individuals with a cumulative average follow-up of almost half a million patient-years. These studies have shown that beyond glycemic control, six drugs-Empagliflozin, Canagliflozin, Dapagliflozin, Liraglutide, Semaglutide, and Dulaglutide belonging to two new therapeutic classes, significantly reduce the cerebrovascular, cardiovascular, and renal morbidity and mortality of T2DM patients. Thus, establishing a new paradigm in the pharmacological treatment of T2DM, the paradigm of cerebral and cardio-renal protection of the diabetic individual. This substantial evidence has been transferred to the T2DM practice guidelines and, for the first time in this medical field, has been homologated around the world.
It is important to note that even before the pandemic, several authors have already advocated cardiac rehabilitation done remotely, or telerehabilitation.Programs addressing various components of rehabilitation, including physical activity, have been proposed by different organizations [5,6].In the context of the new coronavirus pandemic, entities such as the American Association for Preventive Cardiology, advocate telerehabilitation as an excellent strategy for patients with cardiovascular diseases who cannot travel to cardiac rehabilitation centers, both because of mobility difficulties and because of proposals for physical isolation resulting from the COVID-19 pandemic [7].A recent publication suggests that remote cardiac rehabilitation programs should be implemented during the pandemic, since the risks of physical inactivity outweigh the risks of well-planned programs [8].Thus, this point of view aims to propose a physical exercise program done at home and guided by an online physical education professional, for people with cardiovascular diseases. Home-Based Physical Exercise Program Guided by an Online Physical Education ProfessionalThe innCARDIO exercise program: Exercise Cardiology consists of 4 phases: 1) pre-participation assessment in physical exercise programs; 2) obtaining morphological measures (assessment of body fat distribution); 3) training prescription, with individualized physical exercise guidance at the appropriate levels for each participant [9] and; 4) monitoring/supervision of training through weekly teleconsultations.Phase 1 includes the assessment of the individual's health profile and stratification of cardiovascular risk [10].At this stage, those classified as medium/high risk are initially referred for consultation with a cardiologist to perform complementary exams and evaluate the
Background and Objectives: Rapid diagnosis and treatment of cardiovascular diseases is really helpful in reducing further complications. There are different modalities for this goal but each has benefits and limitations. Exercise Treadmill Test (ETT) is a non-invasive, cheap and accessible test. Coronary CT Angiography (CTA) is recently considered as an applied modality for assessing severity of Coronary Artery Disease (CAD). In this study we aimed to investigate possible association between Heart Rate Recovery (HRR) in ETT and severity of CAD in CTA.
Background: Heart failure is a growing problem with a progressive increase in the number of patients as a result of better treatment outcomes and medical interventions.Patients with advanced heart failure who are not candidates for heart transplantation or left ventricular assist device become a major challenge for the health system, as they have a high mortality and hospitalization rate.Intermittent levosimendan infusion has been used in this group of patients even though the evidence is still controversial. Objective:The purpose of this study is to determine the efficacy of intermittent levosimendan infusion in patients with advanced heart failure. Methods:We conducted a systematic review of the literature on EMBASE, EPISTEMONIKOS, MEDLINE/Pubmed and Trip database until January 2018.We included published randomized clinical trials and meta-analysis without language restriction.Results: Eleven studies including 586 patients evaluating intermittent levosimendan infusions in patients with advanced heart failure were included for evaluation.After a follow up period between 3 and 12 months there was a 55% reduction in mortality Odds Ratio (OR) 0.45 CI 95% (0.26; 0.78.p<0.003), a reduction in natriuretic peptide levels and an improvement in left ventricular ejection fraction without a reduction in hospitalization rates.Conclusions: Intermittent levosimendan infusions in patients with advanced heart failure showed significant benefit in patients with advanced heart failure with mortality reduction becoming a promising alternative in the treatment of this group of patients.
Furthermore, the increase of HRV during childhood demonstrated the same uniform pattern of the power spectra without an additional increase in the HF to LF ratio after age three years (Figure 2).Contrary to most previous studies, Herzig D, et al. found no increase of standard HRV parameters with age in children; however, when adjusted for heart rate, there was a significant decrease of HRV parameters with increasing age [3].Plaza-Florido A, et al. also proposed HRV correction for heart rate and the parameters became independent on both sex and heart rate, and only poorly dependent on age [4].We currently work on a concept concerning heart rate regulation in children with anorexia nervosa, proposing that HCN4 regulation (hyperpolarization-activated cyclic nucleotide-gated cation channel) may explain the significant changes in heart rate and HRV during refeeding.This theory based on investigations into heart rate regulation on the receptor, ion current, and molecular level in the sinus node predict further regulatory systems [5] in addition to the acetylcholine and norepinephrine receptors representing the dual
The interest about mindfulness has been increased in the last decades.The epidemiological studies shows a hike from communicable diseases to non-communicable diseases indicating that the adults are more prone for anxiety related, mindfulness related and autonomic variables like heart rate, heart rate variability and related issues.State anxiety is a topic of discussion among all age groups and the way it reflects on sympathetic and parasympathetic nervous system is also eye catchy in the field of psycho physiological research.This study tired to understand the impact of state anxiety and mindfulness on cardiac autonomic regulation on heart rate variability.Eighty three subjects were assessed using state anxiety and mindfulness questionnaire and heart rate variability measurement in Biopac equipment.The result showed a negative correlation between mindfulness and state anxiety (r= -.942, P<0.001).State anxiety increases sympathetic activity (P<0.05) and decreases parasympathetic activity of Autonomic Nervous System (P<0.05).Whereas, mindfulness increases parasympathetic activity (P<0.05) and decreases sympathetic tone (P<0.05).The study could bring up the importance of improving the mindfulness, bringing down the anxiety, and there by balancing cardiac nerves of sympathetic and parasympathetic nervous system.
Large cohort epidemiological studies have shown a U-shaped association between the relative risk of Sudden Cardiac Death (SCD) and the dose of alcohol consumed across both genders.The mechanisms of this relationship, i.e., too little or too high promoting SCD while moderate doses providing protection, remain elusive.In this brief review, we provide plausible electrophysiological and biochemical mechanisms of the U-shaped association of the dose of alcohol and the risk of SCD.At moderate doses alcohol causes partial cellular uncoupling "paradoxically" improves the conduction at narrow ventricular conducting pathways (source) that adjoins a large tissue mass (sink) eliminating preexisting Unidirectional Conduction (UCB) (from source-to-sink) and preventing re-entry formation.In contrast, higher doses of alcohol by further increasing cellular uncoupling cause conduction block at multiple ventricular sites (wavebreaks) in isolated tissues and patterned monolayers of cardiac myocytes leading to the formation of multiple reentrant and non-reentrant wave fronts simulating fibrillation-like state.In the absence of alcohol, the vulnerable narrow conducting pathways remain unchanged promoting UCB (i.e., conduction block from source-to-sink block) increasing the risk of reentry formation.Re-entry leads to Ventricular Fibrillation (VF), a major cause of SCD.Our hypothesis of U-shaped association between alcohol dose and SCD is based on the preponderance of clinical epidemiological data and on basic experimental studies using intact animal hearts and patterned monolayers of cardiac myocytes with vulnerable narrow strands of conducting pathways (source) abutting to a large tissue mass (sink).in 12 ounces of regular beer (~5% per volume alcohol), in five ounces of wine (~12% per volume alcohol) and 1.5 ounces of spirits (~40% alcohol).Therefore, up to 15 g/day is considered "light-to-moderate, " and greater than 30 g/day is considered "high" [3,4].The potential benefits of light-to-moderate doses of alcohol consumption, however, has not received universal acceptance.A recent systematic review of epidemiological data by The Global Burden of Disease Study by Alcohol Collaborators challenged the health benefits of light-to-moderate levels of alcohol consumption.This meta-analysis concluded that the level of alcohol consumption that minimized harm "across all health outcomes particularly the risk of cancer, was zero" [10].This seeming controversy stems from the fact that certain diseases like Atrial Fibrillation (AF), stroke, [11] hypertension, heart failure, cardiomyopathy, cancer, and liver disease do not manifest any benefit from alcohol, [5,12,13] while other diseases do.The potential mechanisms of the observed benefits of low-to-moderate alcohol consumption in CAD and SCD remain undefined because the observed epidemiologic data are associative and not causative, providing no mechanistic insight by which alcohol causes it's beneficial or its ill effects.Since the questions that motivate
Soon clinicians will have whole genomes of patients. Many genes are helpful in risk stratifying patients. Some under-used genes in heart health risk are the ABO blood group as much research shows linkage with both cardiovascular status as well as behavior and personality.
Since the discovery by a Dutch merchant in the early 20th Century that the drug quinine he was taking to prevent malaria during his frequent trips to the West Indies also prevented his Atrial Fibrillation (AF) [1], drug therapy of cardiac arrhythmias remained largely empirical and at best suboptimal [2]. Slowing of impulse conduction (akin to local anesthetic effects) and increased refractoriness of cardiac tissue as observed with quinidine (quinine’s isomer) still remain the two key parameters, among other mechanisms, that are targeted to control cardiac arrhythmias.
