Pub Date : 2021-08-12DOI: 10.31487/j.jicoa.2021.03.01
Lauren Porras, A. Willson, K. Tamminga, Naima Stennett, Jingru Zhang, F. Lin, J. Berkowitz
Pre-participation examination (PPE) is mandatory for United States high school athletes. Despite evidence suggesting increased detection of cardiac disease associated with sudden cardiac death (SCD), obtaining a resting 12-lead electrocardiogram (ECG) is not required for pre-participation evaluation. We queried local high school athletes undergoing PPE between 2017-2019 to gauge interest in having an ECG performed during their PPE. We also evaluated willingness to pay for an ECG and potentially other tests if screening ECG is abnormal. There were 149 respondents, of whom 104 (70%) were male. 18 (12%) respondents were African American (AA) and 30 (20%) played basketball. Regarding interest in ECG, 77 (52%) were unsure, 41 (28%) responded ‘yes’ and 31 (21%) responded ‘no’. Of those not interested in ECG, 11 (35%) played basketball, 23 (74%) were male and 5 (16%) were AA. Basketball players were less likely to want an ECG (p-value 0.002). 48 athletes responded that they would pay for an ECG, 3 (6%) of whom were AA. 46 responded that they would not pay, 13 (28%) of whom were AA (p-value 0.005). Most athletes and parents were unsure about ECG screening. Among athletes considered highest risk for SCD (males, AA and basketball players), there was disproportionately lower interest in screening or paying for an ECG. Lack of interest might be for many reasons, including lack of knowledge regarding the utility of ECG screening and financial considerations. Our study showed that opt-in ECG screening at PPE would miss many high school athletes at highest risk.
{"title":"Opt-in Electrocardiogram Screening at High-School Physicals Does Not Identify Those at Highest Risk for Sudden Cardiac Death","authors":"Lauren Porras, A. Willson, K. Tamminga, Naima Stennett, Jingru Zhang, F. Lin, J. Berkowitz","doi":"10.31487/j.jicoa.2021.03.01","DOIUrl":"https://doi.org/10.31487/j.jicoa.2021.03.01","url":null,"abstract":"Pre-participation examination (PPE) is mandatory for United States high school athletes. Despite evidence suggesting increased detection of cardiac disease associated with sudden cardiac death (SCD), obtaining a resting 12-lead electrocardiogram (ECG) is not required for pre-participation evaluation. We queried local high school athletes undergoing PPE between 2017-2019 to gauge interest in having an ECG performed during their PPE. We also evaluated willingness to pay for an ECG and potentially other tests if screening ECG is abnormal. There were 149 respondents, of whom 104 (70%) were male. 18 (12%) respondents were African American (AA) and 30 (20%) played basketball. Regarding interest in ECG, 77 (52%) were unsure, 41 (28%) responded ‘yes’ and 31 (21%) responded ‘no’. Of those not interested in ECG, 11 (35%) played basketball, 23 (74%) were male and 5 (16%) were AA. Basketball players were less likely to want an ECG (p-value 0.002). 48 athletes responded that they would pay for an ECG, 3 (6%) of whom were AA. 46 responded that they would not pay, 13 (28%) of whom were AA (p-value 0.005). Most athletes and parents were unsure about ECG screening. Among athletes considered highest risk for SCD (males, AA and basketball players), there was disproportionately lower interest in screening or paying for an ECG. Lack of interest might be for many reasons, including lack of knowledge regarding the utility of ECG screening and financial considerations. Our study showed that opt-in ECG screening at PPE would miss many high school athletes at highest risk.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43177474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Coronary Artery Dissection is a well-known serious complication of invasive procedures (e.g. coronary angiography, balloon angioplasty and surgical cardioplegia) and is due to mechanical injury of the arterial wall by interventional devices used during procedures needing skilled operator to manage it timely. Objective: We wanted to look at these large tears that can dramatically affect blood flow and result in severe complications to understand where they happen most and how efficient are we at managing them for our patients in limited resources of the Cath-labs in developing countries. Methods: We reviewed the record of 28 (3.4%) cases of large dissection found in 806 patients who underwent coronary angioplasty in Cath lab of Cardiology Department of Dow University of Health Sciences Karachi. We analyzed as per American College of Cardiology/American Heart Association (ACC/AHA) criteria of the type of lesion, chronic total occlusion, calcification, intra-procedural dissection, and vessel site, related complications and management strategies. Results: Among the 806 patients that underwent per-cutaneous coronary intervention during 3 years (2014-2017) period at Cath-lab of Cardiology Department of Dow University of Health Sciences Karachi, 28 (3.4%) patients were found to have extensive dissection. Out of 10 patients who had immediate angioplasty and stenting for closure of dissection 8 patients were successfully treated and 2 (7.1) died during procedures. 8 (28.5%) needed immediate coronary artery bypass surgery. 10 (35.7%) out of the 28 (3.4%) patients were managed by further hospitalization with medical treatment out of them 3 patients needed angioplasty procedures. There were no late deaths. Conclusion: Coronary artery dissection remains a common occurrence during PCI since pre-stent procedures and clinical sequelae have been minimized by the routine use of coronary stents. Rapid recognition and attention to the angiographic appearance of the dissection is essential to the successful management of this complication. None the less, patients with extensive dissection who are free from the manifestation at the end of the procedure can be managed conservatively. Attempts should be made to stabilize extensive dissection during coronary angioplasty so that surgical intervention can be delayed or avoided altogether if possible.
{"title":"Treatment of Iatrogenic Coronary Artery Dissection in Resource Constraint in Cath-Lab, A Retrospective Study","authors":"","doi":"10.33140/coa.06.02.03","DOIUrl":"https://doi.org/10.33140/coa.06.02.03","url":null,"abstract":"Introduction: Coronary Artery Dissection is a well-known serious complication of invasive procedures (e.g. coronary angiography, balloon angioplasty and surgical cardioplegia) and is due to mechanical injury of the arterial wall by interventional devices used during procedures needing skilled operator to manage it timely. Objective: We wanted to look at these large tears that can dramatically affect blood flow and result in severe complications to understand where they happen most and how efficient are we at managing them for our patients in limited resources of the Cath-labs in developing countries. Methods: We reviewed the record of 28 (3.4%) cases of large dissection found in 806 patients who underwent coronary angioplasty in Cath lab of Cardiology Department of Dow University of Health Sciences Karachi. We analyzed as per American College of Cardiology/American Heart Association (ACC/AHA) criteria of the type of lesion, chronic total occlusion, calcification, intra-procedural dissection, and vessel site, related complications and management strategies. Results: Among the 806 patients that underwent per-cutaneous coronary intervention during 3 years (2014-2017) period at Cath-lab of Cardiology Department of Dow University of Health Sciences Karachi, 28 (3.4%) patients were found to have extensive dissection. Out of 10 patients who had immediate angioplasty and stenting for closure of dissection 8 patients were successfully treated and 2 (7.1) died during procedures. 8 (28.5%) needed immediate coronary artery bypass surgery. 10 (35.7%) out of the 28 (3.4%) patients were managed by further hospitalization with medical treatment out of them 3 patients needed angioplasty procedures. There were no late deaths. Conclusion: Coronary artery dissection remains a common occurrence during PCI since pre-stent procedures and clinical sequelae have been minimized by the routine use of coronary stents. Rapid recognition and attention to the angiographic appearance of the dissection is essential to the successful management of this complication. None the less, patients with extensive dissection who are free from the manifestation at the end of the procedure can be managed conservatively. Attempts should be made to stabilize extensive dissection during coronary angioplasty so that surgical intervention can be delayed or avoided altogether if possible.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81856904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-22DOI: 10.21203/RS.3.RS-738277/V1
Samson Getu
This study was aimed to examine the effect of iron deficiency and supplementation on player’s performance: in case of lemo and Ambericho super league football clubs. Experimental study design was employed. Sampling size determination and sampling technique was used purposive sampling technique method and sampling size was determined by classifying player’s age level. The instrument of data collection were anthropometric (age, height, weight and BMI) measured by meter and kilogram, cardiovascular endurance test measured by 12 minute run test and Astrand tridmile test resting heart rate measured by counting heart beat after interval training. The analyses were carried out by using paired sample T test to analyze player’s hematological change and performance change before and after supplementations by using. The result show that there is significant change was scored on hematological and performance efficiency after supplementation of Iron and 12 week training. Based on the result football players in addition to daily food menu they should have supplement iron with managed training intensity.
{"title":"The Effect of Iron Deficiency and Supplementation on Players Performance: In Case of Lemo and Ambericho Super League Football Clubs.","authors":"Samson Getu","doi":"10.21203/RS.3.RS-738277/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-738277/V1","url":null,"abstract":"\u0000 This study was aimed to examine the effect of iron deficiency and supplementation on player’s performance: in case of lemo and Ambericho super league football clubs. Experimental study design was employed. Sampling size determination and sampling technique was used purposive sampling technique method and sampling size was determined by classifying player’s age level. The instrument of data collection were anthropometric (age, height, weight and BMI) measured by meter and kilogram, cardiovascular endurance test measured by 12 minute run test and Astrand tridmile test resting heart rate measured by counting heart beat after interval training. The analyses were carried out by using paired sample T test to analyze player’s hematological change and performance change before and after supplementations by using. The result show that there is significant change was scored on hematological and performance efficiency after supplementation of Iron and 12 week training. Based on the result football players in addition to daily food menu they should have supplement iron with managed training intensity.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89335322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-15DOI: 10.31487/J.JICOA.2021.01.12
V. Vinod, Z. Yousif
Objective: To define the impact of the cardiovascular risk factors on the extent of Coronary Artery Disease in STEMI patients and to identify the common prevalent risk factors that are unrecognized or poorly treated resulting in STEMI among the UAE population. Methods: Retrospective cohort on patients presented to Mediclinic City Hospital from 2011-2016 who underwent Primary Percutaneous Coronary Intervention (PCI) for confirmed ST-Elevation Myocardial Infarction (STEMI). Results: Of the total 104 STEMI patients, 91% were males. Mean (+SD) of 53 (+12.5) years of age. 73% were less than 60 years old. The most prevalent risk factor was hypertension (42%). 38% of diabetics had an HbA1C of >7%. 14% of the dyslipidemic had above target lipid levels in spite of Statin. 100% of the study population had at least 1 risk factor, ≥2 risk factors (97%), ≥3 risk factors (82%). 50% had 1 or more incidental risk factors diagnosed after admission. Dyslipidemia (36%) was the commonest incidental risk factor. The total risk factor counts increased significantly when the incidental or poorly treated risk factors were added to the initial risk factors on admission. Anterior Wall STEMI (38%) was the commonest. Left Anterior Descending Coronary Artery (48%) was the commonest culprit vessel. The majority had Triple Vessel Disease (37%). 37% developed in-hospital complications. Multivessel disease patients had more risk factors than in single-vessel disease but the association between the number of risk factors and disease severity was not statistically significant. The odds of multivessel disease increased with cumulative risk factor categories, but there was no significant trend association. Conclusion: Our study attempted to determine the impact of CVD risk factors on the severity of CAD among STEMI patients who underwent primary PCI. Contrary to other studies, there was no statistical difference noted in the prevalence of CVD risk factors between the single-vessel and multivessel disease. The study did prove that the incidental or under-diagnosed or inadequately treated risk factors had an impact on the severity of CAD. The study stress that every single CVD risk factor should be treated with equal importance. Statistically significant associations need to be confirmed in future studies with a larger number of patients.
{"title":"Cardiovascular Risk Factors Impact on the Severity of Coronary Artery Disease among Acute ST-Elevation Myocardial Infarction Patients in the United Arab Emirates","authors":"V. Vinod, Z. Yousif","doi":"10.31487/J.JICOA.2021.01.12","DOIUrl":"https://doi.org/10.31487/J.JICOA.2021.01.12","url":null,"abstract":"Objective: To define the impact of the cardiovascular risk factors on the extent of Coronary Artery Disease in STEMI patients and to identify the common prevalent risk factors that are unrecognized or poorly treated resulting in STEMI among the UAE population.\u0000Methods: Retrospective cohort on patients presented to Mediclinic City Hospital from 2011-2016 who underwent Primary Percutaneous Coronary Intervention (PCI) for confirmed ST-Elevation Myocardial Infarction (STEMI).\u0000Results: Of the total 104 STEMI patients, 91% were males. Mean (+SD) of 53 (+12.5) years of age. 73% were less than 60 years old. The most prevalent risk factor was hypertension (42%). 38% of diabetics had an HbA1C of >7%. 14% of the dyslipidemic had above target lipid levels in spite of Statin. 100% of the study population had at least 1 risk factor, ≥2 risk factors (97%), ≥3 risk factors (82%). 50% had 1 or more incidental risk factors diagnosed after admission. Dyslipidemia (36%) was the commonest incidental risk factor. The total risk factor counts increased significantly when the incidental or poorly treated risk factors were added to the initial risk factors on admission. Anterior Wall STEMI (38%) was the commonest. Left Anterior Descending Coronary Artery (48%) was the commonest culprit vessel. The majority had Triple Vessel Disease (37%). 37% developed in-hospital complications. Multivessel disease patients had more risk factors than in single-vessel disease but the association between the number of risk factors and disease severity was not statistically significant. The odds of multivessel disease increased with cumulative risk factor categories, but there was no significant trend association.\u0000Conclusion: Our study attempted to determine the impact of CVD risk factors on the severity of CAD among STEMI patients who underwent primary PCI. Contrary to other studies, there was no statistical difference noted in the prevalence of CVD risk factors between the single-vessel and multivessel disease. The study did prove that the incidental or under-diagnosed or inadequately treated risk factors had an impact on the severity of CAD. The study stress that every single CVD risk factor should be treated with equal importance. Statistically significant associations need to be confirmed in future studies with a larger number of patients.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43816731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-05DOI: 10.31487/J.JICOA.2021.01.11
A. E. Amrawy, A. Maghraby, Mahmoud Hasan Abd Elnabi, S. Ayad
Objective: Elderly patients presenting with acute coronary syndrome (ACS) are at higher risk for morbidity, complications and early mortality than younger patients. Elderly are frequently underrepresented in clinical trials. Methods: A descriptive multi-center study including 760 patients admitted with ACS aiming to determine the most frequently encountered cardiovascular risk factors, as well as the in-hospital complications. Results: Of the 760 patients, 42.1% were males with a mean age of 85 years. Non-ST-elevation ACS was encountered in 496 patients (65.3%; NSTEMI 50% and unstable angina 15.3%) while STEMI was encountered in 264 patients (34.7%). Regarding risk factors, 61.1% of patients were hypertensive, 60% were diabetics, 44.7% were smokers, 28.9% had dyslipidemia, 16.8% had a family history of coronary artery disease, and 20% had chronic renal impairment at presentation. 252 patients (33.2%) underwent primary PCI, 440 patients (57.9%) underwent elective PCI, 36 patients (4.7%) underwent coronary artery bypass graft (CABG) surgery while 32 patients (4.2%) were maintained on conservative medical therapy and no patients received fibrinolytic therapy. In-hospital mortality was only 3.7% (28 patients), Cerebrovascular stroke occurred in 16 patients (2.1%) and recurrent infarction occurred only in 8 patients (1.1%). Conclusion: In patients over 80 years presenting with ACS, female sex, hypertension and diabetes were the most frequently encountered cardiovascular risk factors, with more frequent presentation of NSTEMI than STEMI and in-hospital mortality of 3.7%.
{"title":"Pattern of Cardiovascular Risk Factors and Outcomes of Patients Older Than 80 Years and Presenting with Acute Coronary Syndromes","authors":"A. E. Amrawy, A. Maghraby, Mahmoud Hasan Abd Elnabi, S. Ayad","doi":"10.31487/J.JICOA.2021.01.11","DOIUrl":"https://doi.org/10.31487/J.JICOA.2021.01.11","url":null,"abstract":"Objective: Elderly patients presenting with acute coronary syndrome (ACS) are at higher risk for morbidity, complications and early mortality than younger patients. Elderly are frequently underrepresented in clinical trials.\u0000Methods: A descriptive multi-center study including 760 patients admitted with ACS aiming to determine the most frequently encountered cardiovascular risk factors, as well as the in-hospital complications.\u0000Results: Of the 760 patients, 42.1% were males with a mean age of 85 years. Non-ST-elevation ACS was encountered in 496 patients (65.3%; NSTEMI 50% and unstable angina 15.3%) while STEMI was encountered in 264 patients (34.7%). Regarding risk factors, 61.1% of patients were hypertensive, 60% were diabetics, 44.7% were smokers, 28.9% had dyslipidemia, 16.8% had a family history of coronary artery disease, and 20% had chronic renal impairment at presentation. 252 patients (33.2%) underwent primary PCI, 440 patients (57.9%) underwent elective PCI, 36 patients (4.7%) underwent coronary artery bypass graft (CABG) surgery while 32 patients (4.2%) were maintained on conservative medical therapy and no patients received fibrinolytic therapy. In-hospital mortality was only 3.7% (28 patients), Cerebrovascular stroke occurred in 16 patients (2.1%) and recurrent infarction occurred only in 8 patients (1.1%).\u0000Conclusion: In patients over 80 years presenting with ACS, female sex, hypertension and diabetes were the most frequently encountered cardiovascular risk factors, with more frequent presentation of NSTEMI than STEMI and in-hospital mortality of 3.7%.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42416715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urinary chloride (Cl) is the key electrolyte for regulating renin secretion at the macula densa under the ‘tubulo-glomerular feedback’. Whether or not Cl filtrated into the urinary tubules actually associates with plasma renin activity (PRA) in clinical heart failure (HF) remains unclear. Data from 29 patients with acute worsening HF (48% men; 80.3±12 years) were analyzed. Blood and urine samples were immediately obtained before decongestive therapy after the patients rested in a supine position for 20-min. Clinical tests included peripheral blood tests, serum and spot urinary electrolytes, b-type natriuretic peptide (BNP), plasma neurohormones, and fractional urinary electrolyte excretion. In the 29 patients, urinary Cl concentrations inversely correlated with logarithmically transformed PRA (R2 =0.41, p=0.0002). The correlation was weaker in worsening chronic HF patients (R2 =0.32, p=0.01) compared with de novo HF patients (R2 =0.70, p=0.0026). Patients were divided into 2 groups according to the median urinary Cl concentration, a low group and a high group. Compared with the high group (100~184 mEq/L; n=14), the low group (4~95 mEq/L; n=15) exhibited more renal (serum creatinine; 1.45±0.63 vs 1.00±0.38 mg/d, p=0.029) and cardiac (log BNP; 2.99±0.3 vs 2.66±0.32 pg/mL, p=0.008 p=0.008) impairment, and higher PRA (3.42±4.7 vs 0.73±0.46 ng/mL/h, p=0.049), and lower fractional excretion of urinary Cl (1.34±1.3 vs 5.33±4.1%, p<0.0001). The present study provides clinical data on the possible functioning of urinary Cl involved in the mechanism of ‘tubulo-glomerular feedback’, and thus advances our understanding of the clinical meanings of the significance of urinary Cl concentration measurement.
尿氯化物(Cl)是在“小管-肾小球反馈”下调节黄斑致密处肾素分泌的关键电解质。临床心力衰竭(HF)患者滤入尿小管的氯是否与血浆肾素活性(PRA)相关尚不清楚。29例急性加重心衰患者(男性48%;80.3±12年)。患者仰卧休息20分钟后，在降血治疗前立即取血、尿样。临床检查包括外周血、血清和尿电解质、b型利钠肽(BNP)、血浆神经激素和部分尿电解质排泄。29例患者尿Cl浓度与对数变换后的PRA呈负相关(R2 =0.41, p=0.0002)。慢性HF恶化患者与新发HF患者的相关性较弱(R2 =0.32, p=0.01) (R2 =0.70, p=0.0026)。根据尿Cl中位浓度将患者分为低、高两组。与高剂量组(100~184 mEq/L;n=14)，低剂量组(4~95 mEq/L;N =15)表现出更高的肾(血清肌酐;(1.45±0.63 vs 1.00±0.38 mg/d, p=0.029)和心脏(log BNP;(2.99±0.3 vs 2.66±0.32 pg/mL, p=0.008 p=0.008))损伤，PRA升高(3.42±4.7 vs 0.73±0.46 ng/mL/h, p=0.049)，尿Cl分数排泄降低(1.34±1.3 vs 5.33±4.1%，p<0.0001)。本研究为尿Cl在“小管-肾小球反馈”机制中可能发挥的作用提供了临床资料，从而加深了我们对尿Cl浓度测量意义的临床意义的认识。
{"title":"Clinical Significance of Spot Urinary Chloride Concentration Measurements in Patients with Acute Heart Failure: Investigation on the Basis of the ‘TubuloGlomerular Feedback’ Mechanism","authors":"","doi":"10.33140/coa.06.01.04","DOIUrl":"https://doi.org/10.33140/coa.06.01.04","url":null,"abstract":"Urinary chloride (Cl) is the key electrolyte for regulating renin secretion at the macula densa under the ‘tubulo-glomerular feedback’. Whether or not Cl filtrated into the urinary tubules actually associates with plasma renin activity (PRA) in clinical heart failure (HF) remains unclear. Data from 29 patients with acute worsening HF (48% men; 80.3±12 years) were analyzed. Blood and urine samples were immediately obtained before decongestive therapy after the patients rested in a supine position for 20-min. Clinical tests included peripheral blood tests, serum and spot urinary electrolytes, b-type natriuretic peptide (BNP), plasma neurohormones, and fractional urinary electrolyte excretion. In the 29 patients, urinary Cl concentrations inversely correlated with logarithmically transformed PRA (R2 =0.41, p=0.0002). The correlation was weaker in worsening chronic HF patients (R2 =0.32, p=0.01) compared with de novo HF patients (R2 =0.70, p=0.0026). Patients were divided into 2 groups according to the median urinary Cl concentration, a low group and a high group. Compared with the high group (100~184 mEq/L; n=14), the low group (4~95 mEq/L; n=15) exhibited more renal (serum creatinine; 1.45±0.63 vs 1.00±0.38 mg/d, p=0.029) and cardiac (log BNP; 2.99±0.3 vs 2.66±0.32 pg/mL, p=0.008 p=0.008) impairment, and higher PRA (3.42±4.7 vs 0.73±0.46 ng/mL/h, p=0.049), and lower fractional excretion of urinary Cl (1.34±1.3 vs 5.33±4.1%, p<0.0001). The present study provides clinical data on the possible functioning of urinary Cl involved in the mechanism of ‘tubulo-glomerular feedback’, and thus advances our understanding of the clinical meanings of the significance of urinary Cl concentration measurement.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"77 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76713687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A function of the Parasympathetic and Sympathetic (P&S) nervous systems is to maintain proper tissue perfusion, including of the heart and brain upon head-up postural change standing. Orthostatic dysfunction (OD) is associated with pooling of blood in the lower extremities, insufficient vascular support of the heart, and poor brain perfusion. Abnormal P&S responses to standing help to guide therapy for the individual patient. Midodrine is often the primary recommendation to correct P&S dysfunction upon standing. P&S Monitoring (Physio PS, Inc, Atlanta, GA) differentiates OD-subtypes in 2727 cardiology patients, serially tested. P&S Monitoring non-invasively, independently, and simultaneously measures P&S activity, including the normal P-decrease followed by an S-increase with head-up postural change (standing). S-Withdrawal (SW) and P-Excess (PE) are two types of autonomic dysfunction that are associated with OD. SW differentiates OD from Syncope (an S- excess with stand, e.g. Vasovagal Syncope). PE often masks SW by inflating the S-response to stand. OD based solely on BP and HR responses to provocation remains difficult to differentiate, especially early in its development and difficult to track upon follow-up. The latter is important to ensure relief of not only the abnormal BP response to stand (e.g. Orthostatic Hypotension) or HR (e.g. Postural Orthostatic Tachycardia Syndrome) but the SW or PE as well. SW underlies the majority of Dysautonomia patients with lightheadedness (whether masked or not, 82.0%, p=0.0061). Midodrine relieves SW and ultimately Lightheadedness and associated symptoms within 9 months (75.4%, p=0.0323). P&S Monitoring provides more information, enabling earlier and more specific diagnosis and therapy for improved patient outcomes. P&S dysfunction upon standing may be most well relieved by very low doses of oral vasoactive medications such as Midodrine (Proamatine), Mestinon (Pyridostigmine), or Northera (Droxidopa). In this study we focus on Midodrine.
{"title":"Improved Patient Outcomes by Normalizing Sympathovagal Balance: Midodrine and Parasympathetic and Sympathetic Monitoring","authors":"","doi":"10.33140/coa.06.01.02","DOIUrl":"https://doi.org/10.33140/coa.06.01.02","url":null,"abstract":"A function of the Parasympathetic and Sympathetic (P&S) nervous systems is to maintain proper tissue perfusion, including of the heart and brain upon head-up postural change standing. Orthostatic dysfunction (OD) is associated with pooling of blood in the lower extremities, insufficient vascular support of the heart, and poor brain perfusion. Abnormal P&S responses to standing help to guide therapy for the individual patient. Midodrine is often the primary recommendation to correct P&S dysfunction upon standing. P&S Monitoring (Physio PS, Inc, Atlanta, GA) differentiates OD-subtypes in 2727 cardiology patients, serially tested. P&S Monitoring non-invasively, independently, and simultaneously measures P&S activity, including the normal P-decrease followed by an S-increase with head-up postural change (standing). S-Withdrawal (SW) and P-Excess (PE) are two types of autonomic dysfunction that are associated with OD. SW differentiates OD from Syncope (an S- excess with stand, e.g. Vasovagal Syncope). PE often masks SW by inflating the S-response to stand. OD based solely on BP and HR responses to provocation remains difficult to differentiate, especially early in its development and difficult to track upon follow-up. The latter is important to ensure relief of not only the abnormal BP response to stand (e.g. Orthostatic Hypotension) or HR (e.g. Postural Orthostatic Tachycardia Syndrome) but the SW or PE as well. SW underlies the majority of Dysautonomia patients with lightheadedness (whether masked or not, 82.0%, p=0.0061). Midodrine relieves SW and ultimately Lightheadedness and associated symptoms within 9 months (75.4%, p=0.0323). P&S Monitoring provides more information, enabling earlier and more specific diagnosis and therapy for improved patient outcomes. P&S dysfunction upon standing may be most well relieved by very low doses of oral vasoactive medications such as Midodrine (Proamatine), Mestinon (Pyridostigmine), or Northera (Droxidopa). In this study we focus on Midodrine.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79051234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure (HF) is caused by many factors that lead to myocardial damage, myocardial remodeling of ventricular overload, dysfunction of cardiac diastolic and systolic function, and insufficient blood volume of cardiac circulation. The process of myocardial remodeling is accompanied by myocardial cell ischemia, necrosis, apoptosis, progressive interstitial cell fibrosis and other pathological processes, which is a clinical syndrome in the final stage of various heart diseases, it has high morbidity and mortality, which is a serious threat to human health [1]. Early detection of HF and effective treatment to reduce its morbidity and mortality is particularly important. In recent years, it has been found that Cystatin C (Cys C) is closely related to the occurrence, development and prognosis of HF, and may be an independent predictor of HF. This article reviews the research progress on the relationship between serum Cys C and HF, as well as the pathogenesis, diagnosis, severity and prognosis of Cys C in HF.
{"title":"Research Progress on the Relationship between Serum Cystatin C and Heart Failure","authors":"","doi":"10.33140/coa.06.01.01","DOIUrl":"https://doi.org/10.33140/coa.06.01.01","url":null,"abstract":"Heart failure (HF) is caused by many factors that lead to myocardial damage, myocardial remodeling of ventricular overload, dysfunction of cardiac diastolic and systolic function, and insufficient blood volume of cardiac circulation. The process of myocardial remodeling is accompanied by myocardial cell ischemia, necrosis, apoptosis, progressive interstitial cell fibrosis and other pathological processes, which is a clinical syndrome in the final stage of various heart diseases, it has high morbidity and mortality, which is a serious threat to human health [1]. Early detection of HF and effective treatment to reduce its morbidity and mortality is particularly important. In recent years, it has been found that Cystatin C (Cys C) is closely related to the occurrence, development and prognosis of HF, and may be an independent predictor of HF. This article reviews the research progress on the relationship between serum Cys C and HF, as well as the pathogenesis, diagnosis, severity and prognosis of Cys C in HF.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88808377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary atherosclerotic heart disease is a common disease which seriously endangers human health. The incidence rate is increasing year by year and the age of onset is becoming younger. As a kind of Inflammatory factors of vascular, Lipoprotein associated Phospholipase A2 (Lp-PLA2) can promote the progress of inflammation and coronary atherosclerosis, and its serum level can reflect the stability of atherosclerotic plaque. Among the risk factors of coronary heart disease, Lp-PLA2, as a supplement to the traditional risk factors, has a significant reference value for the prediction of coronary heart disease. More and more studies have found that Lp-PLA2 has a significant potential value in evaluating the prognosis of coronary heart disease, especially in acute coronary syndrome patients. This review summarizes the research progress of Lp-PLA2 on the pathogenesis, detection methods, independent risk factors of predicting coronary heart disease and the treatment and prognosis evaluation of coronary heart disease.
{"title":"Research Progress on the Relationship between Lipoprotein Associated Phospholipase A2 and Coronary Atherosclerotic Heart Disease","authors":"","doi":"10.33140/coa.06.01.03","DOIUrl":"https://doi.org/10.33140/coa.06.01.03","url":null,"abstract":"Coronary atherosclerotic heart disease is a common disease which seriously endangers human health. The incidence rate is increasing year by year and the age of onset is becoming younger. As a kind of Inflammatory factors of vascular, Lipoprotein associated Phospholipase A2 (Lp-PLA2) can promote the progress of inflammation and coronary atherosclerosis, and its serum level can reflect the stability of atherosclerotic plaque. Among the risk factors of coronary heart disease, Lp-PLA2, as a supplement to the traditional risk factors, has a significant reference value for the prediction of coronary heart disease. More and more studies have found that Lp-PLA2 has a significant potential value in evaluating the prognosis of coronary heart disease, especially in acute coronary syndrome patients. This review summarizes the research progress of Lp-PLA2 on the pathogenesis, detection methods, independent risk factors of predicting coronary heart disease and the treatment and prognosis evaluation of coronary heart disease.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74952496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-25DOI: 10.31487/J.JICOA.2021.01.08
M. Temgoua, J. Boombhi, J. Tochie, A. Owona, S. Kingue
Cardiac Arrhythmias (CA) are major cause of death and disability worldwide. In Africa, a continent of poor resources, there is lack of trained specialists for adequate management of these patients. In this article, we propose a practical approach for capacity building of general practitioners to improve easy and timely recognition and better management of CA in Africa.
{"title":"Capacity Building for the Diagnosis and Management of Cardiac Arrhythmias in Africa","authors":"M. Temgoua, J. Boombhi, J. Tochie, A. Owona, S. Kingue","doi":"10.31487/J.JICOA.2021.01.08","DOIUrl":"https://doi.org/10.31487/J.JICOA.2021.01.08","url":null,"abstract":"Cardiac Arrhythmias (CA) are major cause of death and disability worldwide. In Africa, a continent of poor\u0000resources, there is lack of trained specialists for adequate management of these patients. In this article, we\u0000propose a practical approach for capacity building of general practitioners to improve easy and timely\u0000recognition and better management of CA in Africa.","PeriodicalId":93027,"journal":{"name":"Journal of integrative cardiology open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45424782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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