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At least 451 records · Page 25Linked to original sources
PubMed2001

[Cracovian Program for Secondary Prevention of Ischaemic Heart Disease. The quality of care in the field of secondary prevention of ischaemic heart disease depends on where patients are treated in the postdischarge period].

UNLABELLED: Even though the majority of actions undertaken within the secondary prevention ischaemic heart disease should be initiated while the patient is still hospitalized, the maximal benefit (measured as decreased cardiovascular risk) achieved depends mostly on the continuation and modifications of those actions in the post-discharge period. There is not much known about the quality of medical care provided for patients after hospitalization due to ischaemic heart disease. The aim of the study was to assess the quality of post-discharge care in the field of secondary prevention of ischaemic heart disease in patients treated in hospital outpatients (HO), private practice (PP), and by general practitioners (GP). METHODS: Consecutive patients (age>70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: acute myocardial infarction, unstable angina, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. Risk factors and medication used were assessed 6-18 months after discharge. RESULTS: There was no significant differences in smoking, high blood pressure (>140/90 mmHg), and high fasting glucose (>6.0 mmol/l) between the study groups. High total cholesterol was found in 57.5%, 71.2% (p<0.05 vs HO) and 76.2% (p<0.05 vs HO) patients from HO, GP and PP group, respectively. Antiplatelet drugs were used in 83.5%,72.9% (p<0.05vs HO) and 67.4% (p<0.05vsHO), beta-blockers in 65.4%, 54.2% (p<0.05<HO) and 62.8%, lipid-lowering drugs in 48.9%, 18.6% (p<0.0001 vs HO) and 34.9% in HO, GP and PP group, respectively. CONCLUSION: Hypercholesterolemia management as well as use of antiplatelets was the best in hospital outpatients.

Adrenergic beta-Antagonists↗
PubMed1978

Aschoff bodies at necropsy in valvular heart disease. Evidence from an analysis of 543 patients over 14 years of age that rheumatic heart disease, at least anatomically, is a disease of the mitral valve.

Among 543 necropsy patients over age 14 years with severe chronic valvular heart disease, Aschoff bodies were found in 11 patients (2%). The ages of the 11 patients ranged from 18 to 68 years (avg. 38), and nine had had a history of acute rhematic fever earlier in life. Clinically, nine of the 11 patients had mitral stenosis with or without dysfunction of one or more other cardiac valves, one had isolated aortic regurgitation, and one had both mitral and aortic regurgitation. All 11 patients had diffuse fibrous thickening of the mitral valve leaflets, and all but one had diffuse anatomic lesions of at least one other cardiac valve. No patient with anatomic lesions limited to the aortic valve had Aschoff bodies. Thus, among patients with chronic valvular heart disease, Aschoff bodies, the only anatomic lesion pathognomonic of rheumatic heart disease, indicate diffuse anatomic lesions of the mitral leaflets and usually also anatomic lesions of one or more other cardiac valves. The functional mitral lesion is usually stenosis.

Adolescent↗
PubMed1981

Coronary-prone behavior and coronary heart disease: a critical review. The review panel on coronary-prone behavior and coronary heart disease.

A panel of biomedical and behavioral scientists were charged with the task of critically evaluating all available research and theory linking behavior to coronary heart disease. The task was divided into five topic areas: (1) association of coronary-prone behavior and coronary heart disease; (2) assessment of the "type A" behavior pattern; (3) physiologic mechanisms linking behavior to coronary heart disease; (4) cultural and developmental factors; and (5) intervention strategies. The review panels developed summary statements which delineated the perceived strengths and short-comings of the theory and data for their respective sections and provided recommendations to the National Heart, Lung, and Blood Institute concerning future research.

Angina Pectoris↗
PubMed1999

Dilemmas in the management of rheumatic heart disease.

Rheumatic heart disease (RHD) is a major health care problem in India and will continue to be so for few more decades. As there is no vaccine against RHD, it is difficult to control the disease. Besides RHD, most children have other preventable ailments as well. Hence the schools, specially for the poor, must act as primary and preventive health care centres. Prevention of RHD starts with school prophylaxis. Primary, secondary and tertiary prophylaxis play their roles afterwords. After the heart valves have been damaged, tertiary prevention might minimise further damage. For mitral stenosis, closed mitral valvotomy (CMV), open mitral valvotomy (OMV) and interventional mitral valvotomy (IMV) are the different options but none is curative. Valve replacement poses many problems and therefore valvotomy is deferred as far as possible. Mild or moderate mitral regurgitation (MR) is best treated medically. For more advanced disease repair or replacement is the option. For aortic stenosis (AS), valvotomy may be preferred to replacement wherever feasible and for aortic regurgitation (AR) repair is not yet well established. In combined mitral and aortic valve disease it is important to assess both the valves carefully and try to repair one or both the valves and to avoid double valve replacement as far as possible. Once the heart valve is damaged any treatment is palliative, hence all efforts should be directed towards prevention of RHD. Indian Medical Association can play a major role in this endeavour and help children in India to grow up free from RHD.

Adult↗
PubMed2003

Lipid changes on hormone therapy and coronary heart disease events in the Heart and Estrogen/progestin Replacement Study (HERS).

BACKGROUND: Despite the effect of lowering low-density lipoprotein cholesterol (LDL-C) levels and raising high-density lipoprotein cholesterol (HDL-C) levels, combination hormone therapy did not reduce the incidence of coronary heart disease (CHD) events in the Heart and Estrogen/progestin Replacement Study (HERS). To explore possible mechanisms, we examined the association between lipid changes and CHD outcomes among women assigned to hormone therapy. METHODS: HERS participants were postmenopausal women with previously diagnosed CHD who were randomly assigned to receive conjugated estrogens and medroxyprogesterone or identical placebo and then followed-up for an average of 4.1 years. Among women assigned to hormone therapy, associations between baseline-to-year-1 lipid level changes and CHD events were compared with the associations observed for baseline lipids using multivariate proportional hazards models. RESULTS: Among women assigned to hormone therapy, CHD events were independently predicted by baseline LDL-C levels (relative hazard [RH] 0.94 per 15.6 mg/dL decrease, 95% CI 0.88-1.01) and HDL-C levels (RH 0.89 per 5.4 mg/dL increase, 95% CI 0.81-0.99), but not by triglyceride levels (RH 1.01 per 13.2 mg/dL increase, 95% CI 0.97-1.06). CHD events were marginally associated with first-year reductions in LDL-C levels (RH 0.95 per 15.6 mg/dL decrease, 95% CI 0.86-1.04), and were not associated with increases in HDL-C levels ( RH 1.03 per 5.4 mg/dL increase, 95% CI 0.91-1.16) or triglyceride levels (RH 1.01 per 13.2 mg/dL increase, 95% CI 0.98-1.05). CONCLUSION: Changes in lipid levels with hormone therapy are not predictive of CHD outcomes in women with heart disease in the HERS trial.

Aged↗
PubMed2001

[Medical-surgical management of heart disease at birth: what approach for what heart disease?].

The surgical repair of congenital heart defects is governed by three rules: 1) the repair must be as physiological as possible; 2) the cumulated perioperative risk must be reasonable; and 3) the repair must allow normal quality and expectation of life. Surgical management of congenital heart defects at birth also depends upon the hemodynamic status of the newborn, particularly the quality of the intracardiac mixing and the ventricles' function. The possible surgical approaches (simple bi-ventricular, complex bi-ventricular, univentricular) are briefly described. One must recall that the first operation is the most important.

Cardiovascular Surgical Procedures↗
PubMed1981

The Belgian Heart Disease Prevention Project: type "A" behavior pattern and the prevalence of coronary heart disease.

A relation between the Type A behavior pattern and the prevalence of coronary heart disease (CHD), independent of other coronary risk factors, was demonstrated in the Belgian Heart Disease Prevention Project. The association was strongest with angina pectoris or with electrocardiogram (ECG) abnormalities in subjects with known CHD; however, particular aspects of the Type A behavior pattern dealing with time urgency were also related to ECG abnormalities in patients with no angina pectoris and no history of CHD.

Adult↗
PubMed1997

Accuracy of routine ultrasonography in screening heart disease prenatally. Gruppo Piemontese for Prenatal Screening of Congenital Heart Disease.

The aim of the present study was to assess the accuracy of the four-chamber view as a screening test for detection of congenital heart disease (CHD) prenatally in a low-risk population. A prospective observational study was conducted in 17 ultrasound units of the Piemonte Region, Italy, in pregnancies with no risk factors for CHD. At each routine scan, from 18 weeks of gestational age, the four-chamber view of the heart was looked for. When an anomaly was suspected, the patients were referred to a specialized unit. Follow-up of the babies until discharge from the hospital was obtained. 11,232 sonograms were performed on 8299 pregnancies. Cardiac malformations were diagnosed in 40 newborns (4.8/1000). Six of them (15 per cent) had been recognized in utero. The sensitivity, specificity, and positive and negative predictive values were 15, 99.9, 50, and 99.6 per cent, respectively. When malformations that are not associated with an abnormal four-chamber view were excluded from the analysis, the sensitivity increased to 35.3 per cent. The sensitivity found in this study is low, but it is probably realistic since it is comparable to that reported in other multicentric studies. This type of study should reflect the state of the art of the method applied in the field. Although the sensitivity is low, it would be nil if the test were not performed. Moreover, it will probably increase with better training of the operators and by extending the examination to the ventriculo-arterial connections.

Female↗
PubMed1993

Involvement of transforming growth factor-beta in the formation of fibrotic lesions in carcinoid heart disease.

Carcinoid heart disease is a complication of a neuroendocrine carcinoid tumor. Morphologically, it is characterized by the formation of fibrotic plaques with deposition of extracellular matrix in the subendocardium, frequently causing heart valve dysfunction and cardiac failure. Because members of the transforming growth factor-beta (TGF-beta) family are known to stimulate fibroblasts in their production of extracellular matrix, we investigated the expression of the three isoforms of TGF-beta and the binding protein for latent TGF-beta 1 (LTBP) in carcinoid plaques of the right side of the heart, as well as from control tissue, using immunohistochemistry. Tissue specimens were obtained intraoperatively from nine consecutive patients undergoing valve replacement surgery. TGF-beta 1 and TGF-beta 3 were detected in the fibroblasts of all plaques analyzed, whereas TGF-beta 2 was only rarely expressed. The localization of LTBP was partly concordant with that of TGF-beta 1, but the positive staining for LTBP was extracellular. Sections from unaffected heart tissue contained few fibroblasts in the subendocardium, showing only weak or no immunostaining for TGF-beta 1, -beta 2, and -beta 3 and no staining for LTBP. These results suggest that TGF-beta may play a role in the proliferation of fibroblasts and their matrix production in carcinoid heart lesions.

Adult↗
PubMed1998

Risk factors for coronary heart disease in Asian Indians: clinical implications for prevention of coronary heart disease.

Contrary to popular belief that coronary heart disease (CHD) is uncommon in developing countries, Asian Indians have among the highest prevalence of CHD. Analysis of numerous studies have now revealed that the usual risk factors i.e. hypertension, hypercholesterolemia, obesity, smoking and a family history of CHD, are not common among South Asians. Rather, they possess a different risk factor profile characterized by high triglycerides, low HDL, glucose intolerance, insulin resistance, abdominal obesity and increased lipoprotein(a) levels. On account of this difference and the alarming explosion of CHD in India, guidelines for prevention of CHD as laid down by the American Heart Association may not be applicable in our population. A judicious diet incorporating commonly used Indian food items and regular exercise will go a long way in effective primary prevention.

Coronary Disease↗