1/24. Lung volume reduction surgery combined with cardiac interventions.OBJECTIVE: Postoperative course and functional outcome were evaluated in patients who underwent lung volume reduction surgery (LVRS) or in combination with valve replacement (VR), percutaneous transluminal coronary angioplasty (PTCA), placement of a stent, or coronary artery bypass grafting (CABG). methods: patients with severe bronchial obstruction and hyperinflation due to pulmonary emphysema were evaluated for lung volume reduction surgery. Cardiac disorders were screened by history and physical examination and assessed by coronary angiography. Nine patients were accepted for LVRS in combination with an intervention for coronary artery disease (CAD). In addition, three patients with valve disease and severe emphysema were accepted for valve replacement (two aortic-, one mitral valve) only in combination with LVRS. Functional results over the first 6 months were analysed. RESULTS: Pulmonary function testing demonstrates a significant improvement in postoperative FEV1 in patients who underwent LVRS combined with an intervention for CAD. This was reflected in reduction of overinflation (residual volume/total lung capacity (RV/TLC)), and improvement in the 12-min walking distance and dyspnea. Median hospital stay was 15 days (10-33). One patient in the CAD group died due to pulmonary edema on day 2 postoperatively. One of the three patients who underwent valve replacement and LVRS died on day 14 postoperatively following intestinal infarction. Both survivors improved in pulmonary function, dyspnea score and exercise capacity. Complications in all 12 patients included pneumothorax (n = 2), hematothorax (n = 1) and urosepsis (n = 1). CONCLUSION: Functional improvement after LVRS in patients with CAD is equal to patients without CAD. mortality in patients who underwent LVRS after PTCA or CABG was comparable to patients without CAD. LVRS enables valve replacement in selected patients with severe emphysema otherwise inoperable.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/24. Home resistance training in an elderly woman with coronary heart disease.In the current report, a home-based resistive exercise training program was designed for an older woman with coronary artery disease and chronic heart failure, who was unable to participate in a center-based program. With intermittent on-site instruction, the patient was able to learn and perform the designed exercise program. After 6 months of exercise, muscle strength (handgrip and leg extension) and lean body mass were increased, and indicators of physical functional performance were improved. We conclude that a home resistive-based exercise program, with intermittent on-site exercise counseling, may be an effective method for physical training in older coronary patients unable to travel to a rehabilitation center. Further study of this intervention in a controlled clinical trial appears warranted.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
3/24. dipyridamole-atropine-induced myocardial infarction in a patient with patent epicardial coronary arteries.BACKGROUND: The diagnostic accuracy of the physical and pharmacological stress echocardiography tests is higher than routine exercise electrocardiography. They have an acceptable safety profile and have been rarely associated with severe adverse effects. CASE REPORT: We present a case of acute anterior myocardial reinfarction immediately after exercise and pharmacological (dipyridamole-atropine) stress echocardiography testing 1 month after successful stent implantation in LAD. Our patient was a 43-year-old man with a history of heavy smoking and hypertension. Remarkably, the stress echocardiogram was non-diagnostic few hours before the infarction occurred. Angiography performed 4 months after the reinfarction revealed neither a culprit lesion nor stent thrombosis. CONCLUSION: Aggressive "last generation" pharmacological stress testing may provide optimal diagnostic accuracy, but as in our case, complications may occur, even after negative stress testing. To our knowledge, this is the first reported case of an acute myocardial infarction as a severe complication of stress testing, which developed in a patient after stent implantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/24. Hemodynamic determinants of exercise ST-segment depression in coronary patients.Eight patients with coronary heart disease were studied during two periods of exercise separated by 30 min of rest; workload was increased in a stepwise fashion every minute of exercise up to a level that produced limiting symptoms of angina, fatigue, or dyspnea. The magnitude of ST-segment depression and the central aortic pressure were measured during exercise and recovery periods, and myocardial oxygen requirements were estimated by the pressure-time index (systolic aortic pressure x heart rate x ejection time). Seven of the eight patients exhibited a close relationship (r ranged from 0.74 to 0.98) between magnitude of exercise ST-segment depression and indices expressing myocardial oxygen requirements; heart rate, blood pressure, and ejection time were also related to magnitude of exercise ST-segment depression. These relationships were reproducible during two consecutive exercises. Like onset of angina, magnitude of exercise ST-segment depression is usually related to hemodynamic factors influencing myocardial oxygen needs. Consequently, comparisons of exercise-induced ST depression before and after therapy (drugs, physical training, and surgery) are valid only if ECG findings are compared at the same level of myocardial oxygen requirements. In contrast, absence of such a relationship during recovery suggests an important difference in mechanisms of the post-exercise electrocardiogram.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/24. Utility of hand-carried ultrasound for consultative cardiology.Although the stethoscope has been an important part of the bedside cardiac diagnostic examination for generations of physicians, this clinical tool has been relatively unchanged in over 150 years. Echocardiography is established as an essential diagnostic imaging method for patients with known or suspected cardiovascular diseases. However, routine echocardiography systems are large and heavy, and although they are portable, they remain inconvenient for bedside patient rounds. Technologic advances have resulted in miniaturization of electronic components and small, lightweight ultrasound systems have been recently introduced. These hand-carried units offer clinically acceptable two-dimensional image quality for rapid "quick-look" bedside diagnostics, in particular focusing on global and regional left ventricular function and presence or absence of pericardial effusion. This article proposes a general approach to the rapid hand-carried ultrasound cardiac exam as an extension of the physical examination. It details case examples and reviews the initial clinical experience of hand-carried ultrasound on cardiac consultation rounds. hand-carried ultrasound has promise to have an immediate impact on bedside patient management though expediting and facilitating the delivery of medical care.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/24. Metabolic syndrome.The metabolic syndrome is characterized by diabetes mellitus, obesity, hypertension, hyperlipidaemia and polycystic ovary syndrome. The lipid profiles of patient with metabolic syndrome is often characterized by the appearance of hypertrygliceridaemia and small, dense LDL-cholesterol, together with low HDL-cholesterol. patients with these abnormalities are at an increased risk for premature coronary artery disease. Treatment is a multifactorial process and includes modification of lifestyle factors such as diet and physical activity, weight reduction, correction of dyslipidemia, meticulous blood pressure and glycemic control. The case of a 36-year-old woman who develops metabolic syndrome is discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/24. Management of valvular heart disease: an illustrative cases approach.As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. echocardiography, doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/24. Sustained-release diltiazem in patients with effort angina and severe coronary artery sclerosis.Two case histories are presented. Patient 1 was an agricultural worker, aged 63 years, whose attacks of chest pain, diagnosed as effort angina, were relieved by sublingual nitroglycerin. An exercise test revealed ST segment depression of 2 mV in lead V5 of the electrocardiogram. Coronary arteriography disclosed 99% stenosis with delay in segments 7 and 14, 90% stenosis in segment 10, and 25% stenosis in segment 1. Treatment with 100 mg of sustained-release diltiazem relieved some of the symptoms; when the dose was increased to 200 mg daily, no further chest pains were experienced. Patient 2 was a restaurant owner, aged 61 years, who reported attacks of chest pain during physical work. An exercise test revealed ST segment depression of 2 mV in lead aVF; coronary arteriography showed 99% stenosis in segment 7, 75% stenosis in segment 9, and 50% stenosis in segment 10. No attacks of chest pain were experienced after treatment with 200 mg of sustained-release diltiazem daily. blood pressure, heart rate, and the rate-pressure product fell in both patients after diltiazem treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/24. Unstable angina, myocardial infarction and sudden death after an exercise stress test.We performed coronary angiography within 95 minutes of the onset of symptoms in seven patients with an acute coronary event after an exercise stress test. The test was normal in six patients. Previous angiography in four patients revealed no evident or moderate obstructive coronary arterial disease. After the test, unstable angina developed in two patients, acute myocardial infarction in four and ventricular fibrillation in one, who was successfully resuscitated. At acute angiography the coronary artery involved was occluded in four and sub-totally obstructed in three. In three cases, coronary occlusion was due to thrombosis, vasospasm, or both. In six vessels there was an eccentric lesion, which is consistent with a ruptured plaque. These findings show that physical exercise can unexpectedly provoke an acute coronary event with sub-total or total occlusion of a previous angiographically normal or moderately obstructed coronary artery. The mechanism is probably related to exercise-induced plaque rupture which can produce coronary (sub)occlusion by coronary thrombosis, spasm, or both.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/24. The role of nursing in the rehabilitation of women with cardiac disease.This article reviews the literature regarding women with cardiac disease to identify factors that impact their self-definition and rehabilitation. research suggests that women have different physical and psychosocial problems than men during recovery and rehabilitation. A woman's adult development model is described, showing how these factors may affect a woman's self-definition. The implications of these factors are discussed for female clients in a cardiac rehabilitation setting; the implications for nursing and future research are also presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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