January 8, 2007, 9:44 PM CT

Jefferson Cardiologists Fix Broken Heart

Unexplained chest pain after a heart attack might be more dangerous than a number of physicians originally think.

In a case study would be reported in the recent issue of the international journal Clinical Cardiology, physicians at Thomas Jefferson University Hospital in Philadelphia report on a seemingly healthy 55-year-old man who had a silent heart attack and subsequent unexplained chest pain.

Once he was admitted to the hospital, it was discovered that the man actually had a rarely diagnosed complication called subepicardial aneurysm, which, if not quickly treated, could be fatal.

"The chest pain was a rupture of the heart wall about to happen--the most feared complication of a heart attack," explains Michael Savage, M.D., director, Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital. "The rupture occurs from a tear in the muscle that has already been damaged by a heart attack. The heart muscle breaks and the wall bursts commonly causing cataclysmic death soon after".

The Jefferson scientists recommend that when a patient experiences unexplained pain after a heart attack, physicians should consider the possibility of a subepicardial aneurysm.

Diagnosis of a subepicardial aneurysm is extremely rare, says Dr. Savage, who is also associate professor of Medicine, Jefferson Medical College of Thomas Jefferson University. Only 20 cases have ever been published in the medical literature and a number of patients were diagnosed after death. It is highly likely that a number of more patients have died from this complication but the cause of death was unrecognized.........

Posted by: April      Read more         Source

December 28, 2006, 9:01 PM CT

Surgery Can Help When Medicines Fail

Hypertension may seem like something that only adults get, after years of smoking, overeating and little exercise. But children can develop it too -- and just as in adults, uncontrolled hypertension can pose serious risks to children's hearts, brains and lives.

While medications may help some children with high blood pressure, surgery is the best option for those with renal artery obstructions, causing a rare but particularly dangerous form of hypertension. That's the conclusion of a new study reported in the Journal of Vascular Surgery by a University of Michigan Cardiovascular Center team that is among the world's most experienced at treating such children.

Called pediatric renovascular hypertension, the disease is caused by narrowings, or stenoses, in the blood vessels that lead to the kidneys.

It's often diagnosed only after children don't respond to blood pressure medications, or after they experience symptoms such as failing to gain weight at a normal pace or having unexplained fatigue. For some kids, the diagnosis comes only after a stroke.

The condition, which is the third most common cause of serious high blood pressure in children, often develops as a result of developmental narrowings in the renal arteries, the name for vessels that bring blood to the kidneys. In some children, the nearby section of the aorta -- the largest blood vessel in the body -- also has narrowings. Children who have a genetic disease called neurofibromatosis are particularly at risk.........

Posted by: April      Read more         Source

December 23, 2006, 9:17 AM CT

Hypertension Start At Young Age

At what age does hypertension starts showing up. I was thinking may be when you are age 50 or more, or may be when you are at age 40 or more. I was surprised to read this study. Who would believe that hypertension starts at age 10.

By age 10, some African American children already have high nighttime blood pressure according to latest research findings.

As they grow up, black children also show greater increases in nighttime blood pressure, as per a research studythat followed children's blood pressures over 15 years.

Blacks experience less of a dip in nighttime blood pressure than whites. The gap between the pressure measurements of whites and blacks also widens as children get older.

At night, blood pressure should drop because the body is resting, says Dr. Gregory Harshfield, director of MCG's Georgia Prevention Institute and a co-author on the study reported in the Dec. 19 edition of Circulation, the journal of the American Heart Association.

One reason for the higher nighttime pressure is some blacks retain more sodium, which increases fluid volume in their bodies and their blood pressure, as per researchers.

To determine pressure differences between black and white children and at what age those differences occur, Dr. Frank Treiber, vice president for research and co-author of study measured the ambulatory blood pressures of almost 700 children 12 times during 15 years.........

Posted by: April      Read more         Source

December 20, 2006, 9:55 PM CT

When Is Your Next Heart Attak?

Don't you think it would be nice if doctors could predict when a heart attack could happen to you? I think it might be possible in future. Scientists are paving the way for this.

In the latest issue of the New England Journal (NEJM) (NEJM) scientists report findings from a long-term Framingham Heart Study. In this the researchers have identified multiple biomarkers that could predict when you might have your first heart attack.

In the study, researchers followed 3209 participants in the Framingham Heart Study for 10 years and measured 10 of the most promising 'novel' biomarkers for predicting the risk of cardiovascular disease (CVD). The newer biomarkers such as natriuretic peptides, C-reactive protein, fibrinogen, urinary albumin, and homocysteine were compared with established risk factors such as high blood pressure, diabetes, and high cholesterol. Measuring several biomarkers simultaneously, referred to as the "multimarker" approach, enabled the researchers to stratify risk. They observed that persons with high multimarker scores had a risk of death four times as great and a risk of major cardiovascular events almost two times as great according tosons with low multimarker scores. However, the use of multiple biomarkers added only moderately to the overall prediction of risk based on conventional risk factors.........

Posted by: April      Permalink         Source

December 20, 2006, 4:37 AM CT

Are Drug-eluting Stents Worth The Cost?

Over the past 3 decades, percutaneous coronary intervention (PCI, or balloon angioplasty) has significantly changed the therapy of coronary artery disease (narrowing of the arteries supplying the heart muscle). Unlike the more invasive coronary artery bypass graft (CABG) surgery, angioplasty is a nonsurgical procedure in which a tiny catheter with a balloon is inserted into the coronary artery. The balloon is then inflated to push aside the plaque causing the narrowing. Often a stent (wire mesh tube) is left in place to help keep the treated artery open; however, restenosis, or repeat narrowing, of the artery can occur over time. Drug-eluting stents were recently introduced to lower this risk of restenosis and have become an attractive alternative to bare-metal stents. However, they are much more expensive than bare-metal stents, and studies have shown no significant differences in rates of death or heart attack between patient groups receiving either type of stent.

Two articles that will appear in the Jan. 16, 2007, issue of CMAJ provide new insights into the use of drug-eluting stents.

The first is a research article by Grilli and his colleagues in which they compare the use of drug-eluting stents for PCI in public versus private sectors of the Italian medical community. They also evaluate the effect PCI with drug-eluting stents has had on the volume of cardiac surgery, including traditional CABG surgery. They observed that drug-eluting stents were used more frequently in private hospitals, with public hospitals using them more sparingly and selectively in patients with high-risk coronary artery disease. Overall cardiac surgery volumes decreased significantly in the public hospitals but remained stable in the private hospitals. The authors note that future assessments of the impact of drug-eluting stents need to consider the influence of system-wide financial and organizational incentives for adoption of their use.........

Posted by: April      Permalink         Source

December 16, 2006, 8:32 AM CT

Safer Way To Dose Life-saving Heart Drug

Scientists at the University of Illinois at Chicago have taken the dangerous guesswork out of dosing a lifesaving medicine for congestive heart failure.

A new formula developed in the UIC College of Pharmacy will help physicians prescribe the proper amount of the powerful heart drug digoxin. The medicine helps an injured or weakened heart to work efficiently, strengthening the force of the heart muscle's contractions and helping to restore a normal, steady heart rhythm.

Digoxin can be difficult to dose, and there is a small cushion between a beneficial and a deadly level of the drug, said Jerry Bauman, interim dean of the UIC College of Pharmacy. Bauman was the lead investigator of a study that was recently reported in the Archives of Internal Medicine.

"The therapeutic range for digoxin in heart failure has recently changed to become lower and narrower, and the new range is linked to improved mortality," Bauman said. "However, dosing methods have not been modified to reflect this change. In the study, we sought to develop a new method to determine the initial dose of digoxin in patients with heart failure."

Medical records of adult patients who had a steady state of digoxin concentration in their bloodstream were evaluated for six months. An equation was derived using the patients' blood digoxin level, digoxin dose, kidney function, and ideal body weight.........

Posted by: April      Permalink         Source

December 15, 2006, 6:36 PM CT

Blood Pressure Control Improving In The US

More people, particularly the elderly, have their blood pressure under control as per a new study in Hypertension: Journal of the American Heart Association.

While the prevalence of high blood pressure - the proportion of Americans with hypertension - was essentially unchanged from 26.8 percent in 1999-2000 to 29.3 percent in 2003-04, the overall rate of patients who had their hypertension controlled improved significantly, from 29.2 percent in 1999-2000 to 36.8 percent in 2003-04.

"This remarkable jump in the control rate has not been seen previously," said Bernard M.Y. Cheung, Ph.D., author of the study and an associate professor in the University Department of Medicine of Hong Kong. "The increased control rates may help to decrease the occurence rate of strokes and heart attacks, which is highly encouraging".

High blood pressure affects about 60 million adults in the United States, scientists said. It is a major risk factor for heart attack, stroke, heart failure and kidney failure.

In this study, high blood pressure was defined as blood pressure of 140/90 millimeters of mercury (mm Hg) or higher, or taking blood pressure-lowering medication. High blood pressure was considered to be controlled among those on therapy who had an average blood pressure below 140 over 90 mm Hg or below 130 over 80 mm Hg for diabetic patients with high blood pressure.........

Posted by: April      Permalink         Source

December 14, 2006, 9:42 PM CT

Don't Stop Those Statin Pills

Thousands of statin users worldwide are suffering preventable heart attacks, simply because they are not complying with their treatment or are taking too low a dose, according to new research published on-line in European Heart Journal.

These life-saving drugs, used to lower cholesterol levels in people at risk of coronary heart disease (CHD), can only be optimally effective if patients use them properly - and many are not.

That is the conclusion by the research team, who followed the prescription records of nearly 60,000 patients in the Netherlands for up to 14 years.

Dr Fernie Penning-van Beest and colleagues from the PHARMO Institute[2], the Utrecht Institute of Pharmaceutical Sciences and the Academic Hospital in Amsterdam, analysed 548,084 prescriptions of statin treatment issued over the first two years of treatment[3] in 59,094 new users in the period January 1991-December 2004, and followed the patients until their first hospital admission for heart attack, death, or the end of the study in December 2004.

The aim was to see how effective robust statin treatment was for primary and secondary CHD in the 'real world' - as opposed to in clinical trials. Their results enabled them to calculate the absolute number of avoidable heart attacks that occurred because patients had stopped taking their drugs or were not taking them consistently. They were also able to compare the preventive effects of different doses and types of statins.........

Posted by: April      Permalink         Source

December 14, 2006, 9:30 PM CT

Those 2 glasses a day that lengthen your life

A study performed by the Research Laboratories of the Catholic University of Campobasso (Italy) con-firms the beneficial effects that moderate consumption of alcohol has on our health. But this time it is not just cardiovascular disease that gets advantage from this: drinking in moderation reduces all-cause mortality.

The research, published on the American journal Archives of Internal Medicine, assembled 34 scientific studies conducted during the last years worldwide using the statistic procedure of meta-analysis, that al-lows to match different studies to achieve general results. In this way it has been possible to examine data concerning over a million of people, for which alcohol drinking habits were linked to all-cause mortality.

The conclusions scientists from the Catholic University of Campobasso came to clearly show that drinking in moderation (a couple of wine or beer glasses a day) has beneficial effects on health. But that is not all: while the greatest part of the studies conducted on this issue have looked at cardiovascular disease, a term that includes clinical events of various severity, the study published on the Archives of In-ternal Medicine shows a positive effect of alcohol on an unquestionably hard parameter as overall mortality.

Alcohol as a life insurance" Not exactly. The key word is moderation. The Italian research also con-firms that excessive consumption of alcohol is absolutely harmful, and the risk of death for those who drink in excess does not decrease at all. On the contrary: the risk definitely increases.........

Posted by: April      Permalink         Source

December 14, 2006, 9:11 PM CT

New Tool To Halt Atrial Fibrillation

Clinical scientists at the University of Pennsylvania Health System are starting a trial utilizing a new mechanism to treat the heart when its electrical pulses essentially short-circuit, referred to as atrial fibrillation (A-Fib).

The biggest problem physicians run into with current therapies to cope with electrical rhythmic pumping problems in the heart, namely pulmonary vein isolation procedures, is that up until now, they've had to deliver the energy bursts to the tissue in a dot-by-dot catheter ablation procedure around the veins, almost like a string of pearls. "That can cause swelling, and when that swelling goes down, you may still have viable tissue left behind, gaps, where the electricity can still conduct itself or get through," explains David Callans, MD, director of the electrophysiology laboratory at the Hospital of the University of Pennsylvania and principal investigator of this study. "Now we have a mechanism to construct this barricade of lesions, to do an entire circular ablation, minimizing the potential for gaps behind in the pulmonary veins".

Cardiac electrophysiologists at Penn are now using a high intensity focused ultrasound (HIFU) ablation system. It's the first to deliver energy bursts forward in a complete circle, all at once, from outside of the vein. This invasive procedure is done in the lab with balloon catheters while the patient is awake but sedated.........

Posted by: April      Permalink         Source