K disease, a generalized vasculitis of unknown etiology, is a leading cause of acquired heart disease in children in the United States. During the acute phase, Kawasaki disease may cause medium- and large-vessel arteritis, arterial aneurysms, valvulitis, and myocarditis. Of particular concern are coronary artery aneurysms, which may precipitate thrombosis or evolve into segmental stenoses in the chronic phase. This committee's previously published articles on diagnostic criteria and therapeutic recommendations for acute Kawasaki disease"2 defined the clinical and laboratory features of Kawasaki disease, made recommendations about the use of aspirin and intravenous gamma globulin, and discussed unresolved therapeutic issues. In this report, guidelines for the long-term follow-up and management of patients with Kawasaki disease are addressed.
Knowledge of respiratory variation of the amplitude of the pulse in pericardial disease dates back a long way. Some early observers of this phenomenon had remarkably “modern” ideas concerning the underlying mechanisms. In 1619, when describing the case of a young woman with constrictive pericarditis, Lower (See Chapter 6) stated, “. . .the pulse was weak and intermittent ” and that “. . .the pericardium had become thick, opaque and almost callous.” He concluded that the movement of the diaphragm during breathing was the reason why the pulse disappeared during inspiration. This conclusion brought him close to the mechanism of pulsus paradoxus proposed by Auenbrugger (1958) Dock (1961) andWood 1961) but subsequently disproved (Shabetai Fowler Fenton 1965).
Heart failure (HF) is a progressive process and the objective of treatment should be to prevent progression. Treatment should begin at the stage of asymptomatic left ventricular dysfunction (LVD), not only to reduce mortality but also to preserve exercise capacity and quality of life. To prevent clinical progression in patients with asymptomatic LVD or HF, left ventricular remodelling and dilatation must be prevented. The SOLVD prevention trial – the only clinical trial on the prevention of HF – showed that ACE inhibition significantly reduced the development of HF, but did not significantly reduce mortality. Plasma norepinephrine is elevated in patients with asymptomatic LVD, is further elevated in patients with overt HF, and is correlated with increased mortality. Inhibition of the sympathetic nervous system by administration of β-blocking agents is therefore a logical treatment for patients with HF or asymptomatic LVD. Clinical trials have shown that β-blocking agents increase left ventricular ejection fraction and reduce left ventricular dimensions in patients with HF, indicating regression of left ventricular remodelling. Almost all the patients in these studies were receiving an ACE inhibitor as part of their background medication, therefore the relative efficacy of β-blocking agents and ACE inhibitors in the regression of remodelling is not known. CARMEN, a double-blind, randomised, parallel group study of carvedilol versus enalapril versus carvedilol + enalapril in 450 patients with mild HF, will provide this information.
HomeStrokeVol. 25, No. 9Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBGuidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. H P AdamsJr, T G Brott, R M Crowell, A J Furlan, C R Gomez, J Grotta, C M Helgason, J R Marler, R F Woolson and J A Zivin H P AdamsJrH P AdamsJr , T G BrottT G Brott , R M CrowellR M Crowell , A J FurlanA J Furlan , C R GomezC R Gomez , J GrottaJ Grotta , C M HelgasonC M Helgason , J R MarlerJ R Marler , R F WoolsonR F Woolson and J A ZivinJ A Zivin Originally published1 Sep 1994https://doi.org/10.1161/01.STR.25.9.1901Stroke. 1994;25:1901–1914 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Satheeshkumar A, Pena C and Nugent K (2020) Current U.S. Guideline-Based Management Strategies for Special Clinical Situations Involving Hypertensive Crises, Cardiology in Review, 10.1097/CRD.0000000000000364, 30:1, (44-49), Online publication date: 1-Jan-2022. 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When possible, the management of acute cardiogenic pulmonary edema should be started before the patient reaches the hospital. Simple measures such as having the patient sit up with the legs dependent, administering oxygen by nasal prongs, giving sublingual nitroglycerin and small doses of morphine, and rotating tourniquets on the limbs may reduce the need for more intensive procedures. Digoxin and other inotropic agents, aminophylline, furosemide, and vasodilators are given as appropriate during hospitalization. A minority of patients need endotracheal intubation and pressure monitoring with a Swan-Ganz catheter. If the arterial PO2 cannot be maintained at 60 mm Hg or more during face mask ventilation, the PCO2 rises, and the arterial pH declines, the patient should be intubated. Pressure monitoring with a Swan-Ganz catheter is indicated if the patient does not immediately respond to treatment or in special situations such as cardiogenic shock with pulmonary edema. Pulmonary edema caused by diastolic dysfunction is managed differently than that caused by systolic dysfunction. The cause and precipitating factors of the acute pulmonary edema should be sought and treated as early as possible to prevent recurrences.
Barrier methods of birth control are less efficacious than other methods but pose significantly less risk of systemic complications for women with congenital heart disease. These methods require a motivated patient and a cooperative partner. Male contraception was not discussed in this article but certainly should be considered when counseling a couple. At present, essentially the only permanent option for male contraception is a vasectomy, but other methods are under investigation. Sterilization is not recommended uniformly in women with cardiovascular disease when pregnancy is feasible and not contraindicated. It may be considered an option for women with contraindications to pregnancy, but these patients may also be at increased risk from the sterilization procedure.
HomeCirculationVol. 89, No. 6Guidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBGuidelines for the management of transient ischemic attacks. From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks of the Stroke Council of the American Heart Association. W M Feinberg, G W Albers, H J Barnett, J Biller, L R Caplan, L P Carter, R G Hart, R W Hobson2nd, R A Kronmal and W S Moore W M FeinbergW M Feinberg , G W AlbersG W Albers , H J BarnettH J Barnett , J BillerJ Biller , L R CaplanL R Caplan , L P CarterL P Carter , R G HartR G Hart , R W Hobson2ndR W Hobson2nd , R A KronmalR A Kronmal and W S MooreW S Moore Originally published1 Jun 1994https://doi.org/10.1161/01.CIR.89.6.2950Circulation. 1994;89:2950–2965 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Tuna M and Rothwell P (2021) Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis, The Lancet, 10.1016/S0140-6736(20)31961-9, 397:10277, (902-912), Online publication date: 1-Mar-2021. 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