JRSM Cardiovascular Disease最新文献

Introduction: Hypertension is a global challenge which accounts for high morbidity and mortality rates in the world. The availability of effective anti-hypertensive medications does not result in a good outcome in controlling blood pressure which points towards poor adherence. Thus, this study was conducted to assess the determinants of adherence to anti-hypertensive medication among hypertensive patients on follow-up in Hawassa Referral Hospital.

Methods: Institution-based case-control study was conducted on a sample of 289 clients from February to May 2018. Census was conducted on 1600 clients to select cases and controls. Then, systematic random sampling was used to select study subjects, and adherence was measured by Morisky medication adherence scale. The associations of variables were analyzed using bivariable followed by multivariable logistic regression analyses.

Results: The respondent's adherence to medication was found to be 67% as measured by Morisky medication adherence scale. The multivariate logistic regression analysis showed that medication adherence was found to be better in younger age (<45) (AOR = 3.8), clients living in urban areas (AOR = 6.84), those clients who had good knowledge (AOR = 3.13), those with no co-morbidities (AOR = 3.14) and patients who controlled their blood pressure (<140/90) (AOR = 2.35).

Conclusions: The rate of medication adherence was found to be low, and hence educational interventions focusing on factors promoting adherence and patients' health support should be implemented.

Retrieval of tip-embedded inferior vena cava filters using endobronchial forceps is a well-described technique. The tip of dorsally tilted filters may be in proximity to the right renal artery, increasing the risk of arterial injury during retrieval. We present one case that illustrates renal artery injury requiring emergent stent graft repair. The three subsequent cases illustrate techniques that avoid renal artery injury using a femoral and jugular approach with the assistance of an arterial fiducial wire. Renal artery injury is a potential complication during retrieval of filters using endobronchial forceps that can be prevented with careful planning.

Purpose: Percutaneous endovenous iliac stenting has emerged as a new modality in the treatment of advanced chronic venous insufficiency with outflow obstruction. However, the effect of this intervention on the quality of life remains unclear. We examined the impact of iliac venous stenting for outflow obstruction as compared to conservative medical management on the quality of life in severe chronic venous insufficiency patients.

Methods: Medical records of all patients with CEAP class 5 and 6 disease (N = 172) who underwent ilio-caval venography with intravascular ultrasonography (IVUS) at a single institution over a seven-year period, were reviewed for this case-control study. Quality of life evaluation was performed utilizing the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) one year after the index procedure.

Results: Of the 172 severe chronic venous insufficiency patients, 109 were stented and 63 patients were treated medically based on their venography and IVUS results. The indication for stenting was confirmation of IVUS determined surface area or diameter outflow stenosis of greater than 50% within the common or external iliac venous systems. Eighty patients (47%) responded with completed CIVIQ-20 questionnaires for analysis. Of these, 47 were from the stented group and 33 from the non-stented group. At least moderate persistent pain or discomfort post-procedure was reported by 20 (43%) stented group patients and 19 (58%) non-stented group patients. Scores for all the other criteria in the CIVIQ-20 were similar between the groups. The mean total CIVIQ-20 score was 45.23 and 47.13, respectively, in stented group and non-stented group patients. (p = 0.678).

Conclusion: There was no significant difference in the quality of life reported by CEAP 5 and 6 patients who underwent iliac venous stenting versus those who were treated medically for presumed iliac outflow obstruction. Prospective studies are needed to determine the true value of iliac venous stenting based on IVUS criteria in the management advanced chronic venous insufficiency.

Background: Nationally, ischemic heart disease mortality has declined significantly due to advancements in managing traditional risk factors of hypertension, diabetes, hyperlipidemia, smoking, and obesity and acute intervention. However geographic disparities persist that may, in part, be attributed to environmental effects.

Methods: Ischemic heart disease age-adjusted mortality were obtained from the CDC database for years 1999 through 2014 by county, gender, race, and Hispanic origin for the Central Valley of California.

Results: There was an increase in mortality from north to south of 14.9 (95% CI: 8.0-21.9, p value <0.0001) in time period 1, 7.9 (95% CI: 0.8-15, p value <0.05) in time period 2, and 9.2 (95% CI: 4.0-14.3, p value <0.001) in time period 3. In time period 1, the ambient particulate matter ≤2.5 micrometers (PM_2.5) level increased from north to south by 0.84 µg/m³ (95% CI: 0.71-0.96), in time period 2 there was a 0.87 µg/m³ increase (95% CI: 0.74-1.0), and a 1.0 µg/m³ increase in time period 3 (95% CI: 0.87-1.1). PM_2.5 level was correlated to IHD mortality in all time periods (Period 1 r² = 0.46, p = 0.0001; Period 2, r² = 0.34, p = 0.008; Period 3 r² = 0.51, p value <0.0001).

Conclusion: Continued declines in ischemic heart disease mortality will depend on the concerted efforts of clinicians in continuing management of the traditional risk factors with appropriate medication use, acute interventions for coronary syndromes, the necessity of patient self-management of high risk behaviors associated with smoking and obesity, and the development of coordinated actions with policy makers to reduce environmental exposure in their respective communities.

A 56-year-old man who had twice previously undergone orthotopic heart transplantation was admitted with dyspnea and heart failure symptoms. A biopsy excluded rejection. Left heart catheterization revealed a coronary cameral fistula. After the patient was given mild diuretics, his condition improved. No significant fistula flow was detected, and he was discharged. Several months later, the patient was readmitted with worsening chest pain and dyspnea. Left ventricular end-diastolic pressure and flow through the fistula were increased. To correct the coronary cameral fistula, we performed a coil embolization without complications. Several months later at follow-up, the patient's symptoms had resolved, and his left ventricular end-diastolic pressure had normalized. We conclude that coronary fistulas may be caused by trauma to the heart during the de-airing process, which may be prevented in the future with the development of safer and more effective de-airing techniques.