Journal of cardiology & clinical research最新文献

In chronic medical conditions remote patient monitoring (RPM), is beneficial to empower both medical providers and patients. RPM supports medical care and early interventions to potentially promote patient's disease management and improve outcomes. In heart failure, although RPM holds significant promise, published trials provide evidence regarding historical success and failures that inform future efforts. Heart failure has increased in incidence and prevalence during the past years, leading to significant cost. We must find alternate ways to monitor daily disease progression and symptomatology to allow the patient and their health provider react to not only reduce cardiovascular outcomes but reduce hospitalizations and readmission rates. Here we display most up to date studies and analysis of our perspective on the role of RPM in heart failure.

Alcoholism is the third leading cause of preventable death in the United States. Aside from promoting cardiomyopathies, chronic alcohol consumption is associated with an increased risk of dementia, the development of liver or pancreas failure, and cancers of the oral cavity and pharynx. Although a J-shaped curve for all cause mortality has been identified for average alcohol consumption, irregular heavy drinking also carries significantly greater risks for cardiovascular disease. Alcohol induced cardiovascular disease has a complex multigenic etiology. There is significant variation in the initial presentation of alcoholic cardiomyopathy with diastolic dysfunction possibly being the first indication. Ethanol exposure generates toxic metabolites, primarily acetaldehyde and ROS, which activate several cell signaling systems to alter cell function across many levels. Sudden cardiac death is a known occurrence of alcoholism that may be linked to an arrhythmogenic effect of alcohol. Microscopic and molecular examination of diseased hearts has demonstrated abnormal alterations to various cellular components, including the mitochondria and myofibrils. These studies have shown not only the direct impact on myocardial contractility but also disrupted metabolism that determines the long-term survival of the myocardium. Significant variations in the response to chronic alcohol consumption may be related to unique genotypes that modify the metabolic response to ethanol. Future studies to further characterize the role of different genotypes will help indentify those genotypes are more susceptible to chronic alcohol consumption.

Objective: We sought to describe findings, diagnostic yield, cost effectiveness of transthoracic echocardiography (TEE) and Carotid doppler ultrasound (CDU) in ischemic stroke.

Methods: Cross sectional study at Mulago hospital, Uganda. Institutional ethical approval, patient consent was obtained. Patients eighteen years and above with ischemic stroke confirmed by brain computerized tomography (CT) scan and met inclusion criteria were selected. TTE and CDU were done as part of comprehensive assessment for stroke risk factors. Data was analyzed using SPSS 14. Univariate analysis was done for social-demographics, abnormalities on cardiac imaging and diagnostic yield using TOAST criteria. Bivariate analysis for association between stroke risk factors, cardio-embolic stroke and other ischemic subtypes (diagnosed using clinical and CT scan features). Statistical significance was set at P<0.05.

Results: Of 139 screened patients with suspected stroke, 127 underwent brain CT scan as 12 died before CT. Eighty five were confirmed stroke by CT scan with 66 (77.6%) ischemic stroke, mean age 62 years (SD+16.6), 53% were male. Out of 66, 62 (93.9%) underwent both TTE and CDU. Although only 7 (11.3%) reported history of heart disease, 43 (69.3%) had abnormal findings on TTE with left atrial enlargement commonest in 21 (48.8%). Thirty eight (61.3%) had abnormal finding on CDU with atherosclerosis commonest in 28 (45.2%). Using clinical and CT scan features, atherosclerotic stroke was the commonest subtype in 29 (46.8%) then cardio-embolic 18 (27.3%). Only 6 (9.7%) patients had abnormal findings on TTE suggesting possible cardio-embolism by TOAST criteria. None had stenosis >50% on CDU. Multiple valvular lesions P<0.001, severe valvular lesions P=0.001 were associated with cardio-embolic stroke.

Conclusions: Majority of ischemic stroke patients without previous history of heart disease had abnormal findings on TTE and CDU. Diagnostic yield for cardio-embolic stroke by TOAST criteria was very low given the high cost involved for a developing country.