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Cardiac Patients (cardiac + patient)
Selected AbstractsCigarette Smoking and the Risk of Supraventricular and Ventricular Tachyarrhythmias in High-Risk Cardiac Patients with Implantable Cardioverter DefibrillatorsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2006ILAN GOLDENBERG M.D. Introduction: Nicotine elevates serum catecholamine concentration and is therefore potentially arrhythmogenic. However, the effect of cigarette smoking on arrhythmic risk in coronary heart disease patients is not well established. Methods and Results: The risk of appropriate and inappropriate defibrillator therapy by smoking status was analyzed in 717 patients who received an implantable cardioverter defibrillator (ICD) in the Multicenter Automatic Defibrillator Implantation Trial-II. Compared with patients who had quit smoking before study entry (past smokers) and patients who had never smoked (never smokers), patients who continued smoking (current smokers) were significantly younger and generally had more favorable baseline clinical characteristics. Despite this, the adjusted hazard ratio (HR) for appropriate ICD therapy for fast ventricular tachycardia (at heart rates ,180 b.p.m) or ventricular fibrillation was highest among current smokers (HR = 2.11 [95% CI 1.11,3.99]) and intermediate among past smokers (HR = 1.57 [95% CI 0.95,2.58]), as compared with never smokers (P for trend = 0.02). Current smokers also exhibited a higher risk of inappropriate ICD shocks (HR = 2.93 [95% CI 1.30,6.63]) than past (HR = 1.91 [95% CI 0.97,3.77]) and never smokers (P for trend = 0.008). Conclusions: In patients with ischemic left ventricular dysfunction, continued cigarette smoking is associated with a significant increase in the risk of life-threatening ventricular tachyarrhythmias and inappropriate ICD shocks induced by rapid supraventricular arrhythmias. Our findings stress the importance of complete smoking cessation in this high-risk population. [source] Intraoperative Transesophageal Echocardiography in Congenital Heart DiseaseECHOCARDIOGRAPHY, Issue 8 2002F.R.A.C.P., F.R.C.P.(C.)Article first published online: 24 JUL 200, Jeffrey F. Smallhorn M.B.B.S. Intraoperative transesophageal echocardiography has become an integral component of the repair of congenital heart defects. It currently has a direct impact on reducing morbidity and mortality in the pediatric cardiac population. To establish a successful program, it is important to follow guidelines for training as well as having a systematic approach to the evaluation of this patient population. This article addresses the specific indications in a patient population as practiced at the Hospital For Sick Children, Toronto. While there may be subtle differences between programs, the objectives are to provide excellent service to the pediatric cardiac patient in the operating room. [source] The cardiac patient: a gender comparison via illness narrativesJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2009Michal Rassin PhD Aims., To compare responses to heart disease between women and men, aged 30,50 years, and to identify the factors influencing them in health and illness. Background., The quality of life and prognosis for women with heart disease are worse than for men. Methods., Participants were 30 men and 30 women who had coronary heart disease. The study was conducted using a qualitative method based on narrative investigation. Narratives were gathered using in-depth interviews and were analyzed by thematic analysis. Data were collected in 2006. Results., Women often delayed seeking treatment. When they did seek treatment they were often not initially diagnosed as having heart disease. The recovery period for women was characterised by their quick return to daily home making before their physical condition permitted it. Conversely, men extended their recovery period and received family support. Men were strict in following the instructions of the health regimen, whereas most women ignored it. The women, compared to the men, received less support from their spouses and families, and they noted that social expectations concerning their role were high. Conclusions., The role of the cardiac patient is socially formed based on male characteristics and, as a result, men are legitimised and receive social support in all that relates to the disease. Consequently, men adhere to the health regimen, whereas women are less inclined to. Relevance to clinical practice., Improved disease models for women with heart disease are needed, as are specifically design rehabilitation programmes to meet the needs of women with heart disease. [source] Electrophysiological determinants of hypokalaemia-induced arrhythmogenicity in the guinea-pig heartACTA PHYSIOLOGICA, Issue 4 2009O. E. Osadchii Abstract Aim:, Hypokalaemia is an independent risk factor contributing to arrhythmic death in cardiac patients. In the present study, we explored the mechanisms of hypokalaemia-induced tachyarrhythmias by measuring ventricular refractoriness, spatial repolarization gradients, and ventricular conduction time in isolated, perfused guinea-pig heart preparations. Methods:, Epicardial and endocardial monophasic action potentials from distinct left ventricular (LV) and right ventricular (RV) recording sites were monitored simultaneously with volume-conducted electrocardiogram (ECG) during steady-state pacing and following a premature extrastimulus application at progressively reducing coupling stimulation intervals in normokalaemic and hypokalaemic conditions. Results:, Hypokalaemic perfusion (2.5 mm K+ for 30 min) markedly increased the inducibility of tachyarrhythmias by programmed ventricular stimulation and rapid pacing, prolonged ventricular repolarization and shortened LV epicardial and endocardial effective refractory periods, thereby increasing the critical interval for LV re-excitation. Hypokalaemia increased the RV-to-LV transepicardial repolarization gradients but had no effect on transmural dispersion of APD90 and refractoriness across the LV wall. As determined by local activation time recordings, the LV-to-RV transepicardial conduction and the LV transmural (epicardial-to-endocardial) conduction were slowed in hypokalaemic heart preparations. This change was attributed to depressed diastolic excitability as evidenced by increased ventricular pacing thresholds. Conclusion:, These findings suggest that hypokalaemia-induced arrhythmogenicity is attributed to shortened LV refractoriness, increased critical intervals for LV re-excitation, amplified RV-to-LV transepicardial repolarization gradients and slowed ventricular conduction in the guinea-pig heart. [source] New guidelines for cardiac risk assessment prior to non-cardiac surgeryINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 2 2010FA Pickett To cite this article: Int J Dent Hygiene DOI: 10.1111/j.1601-5037.2009.00427.x Pickett FA. New guidelines for cardiac risk assessment prior to non-cardiac surgery. Abstract:, The European Society of Cardiology (ESC) has established guidelines to determine the risk for non-cardiac procedures, such as oral procedures, when individuals have experienced severe cardiac disease, including myocardial infarction. This is the first time the ESC has developed consensus guidelines to assist practitioners in managing care for cardiac patients receiving medical or dental procedures. Factors for risk assessment are described and management for oral care is discussed. [source] Using the cardiac depression scale in men recovering from coronary artery bypass surgeryJOURNAL OF CLINICAL NURSING, Issue 11 2009Kathryn M King Aims., To examine the utility and validate the use of the Cardiac Depression Scale in patients who had first-time coronary artery bypass graft surgery. Background., The Beck Depression Inventory, though frequently used, may not be sufficiently sensitive for use in cardiac patients. The Cardiac Depression Scale has been shown to identify the range of depression in medical cardiac patients. Design., Survey. Methods., The Beck Depression Inventory and Cardiac Depression Scale were administered to 120 men at hospital discharge, as well as six, 12 and 36 weeks postoperatively. Cronbach's , scores were calculated for the measures at each point. Changes in scores over time were analysed using repeated measures analysis of variance. Associations between the measures scores were calculated using Pearson product,moment correlations. Agreement between the measures' dichotomised scores (depression/no depression) was examined using Cohen's Kappa statistic. Results., Internal consistency was similar for the Beck Depression Inventory (0·793,0·904) and Cardiac Depression Scale (0·859,0·910). Depression scores decreased over time with the Beck Depression Inventory [F(2·50, 175·29) = 22·27, p < 0·001] and Cardiac Depression Scale [F(2·68, 190·37) = 13·18, p < 0·001]. The measures had similar power [Cohen's f = 0·65 (Beck Depression Inventory) and 0·43 (Cardiac Depression Scale)] to reveal changes over time. The continuous scores were highly correlated at each point [0·737 (p < 0·001),0·819 (p < 0·001)]. However, when dichotomised scores were compared, the chance corrected level of agreement was less impressive [0·198 (p = 0·014),0·381 (p < 0·001)]. Conclusions., The Cardiac Depression Scale may have utility for use with surgical cardiac patients. However, continued examination of this measure of depression is warranted. Relevance to clinical practice., Given the prevalence of depression and its negative impact on coronary artery disease, it is important to identify even mild depression in cardiac patients. Using a measure of depression specifically for cardiac patients, rather than a generic measure, may best accomplish this goal. [source] Risk factors of Hong Kong Chinese patients with coronary heart diseaseJOURNAL OF CLINICAL NURSING, Issue 7 2007Sek Ying Chair RN Aims and objectives., The aims of the study were to describe the level of modifiable coronary risk factors and to explore the relationships among these risk factors in patients with coronary heart disease. Background., Appropriate patient education and therapies for coronary risk reduction will prevent recurrent cardiac events and progression of coronary heart disease. Therefore, having knowledge of the risk profile of these patients is essential so that appropriate contents and focus of patient educations can be developed. Methods., Coronary heart disease patients admitted for cardiac catheterization at the two studied hospitals in Hong Kong were recruited for this study. Demographic date and risk factors of blood pressure, smoking status, body mass index, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and exercise level were collected from subjects as well as from medical records for analysis. Results., The body mass index was significantly different among non-smoker, ex-smoker and smoker (p = 0·027). Non-smokers had the highest body mass index but smokers had the lowest body mass index among the three groups in this study. Physical inactivity, overweight and hypercholesterolaemia were the risk factors seen in about 50% of the studied subjects. Body mass index correlated positively with systolic blood pressure but negatively correlated with high-density lipoprotein cholesterol and hour of exercise. Conclusions., Heavier subjects had a higher systolic blood pressure but a lower level of high-density lipoprotein cholesterol. Heavier subjects also exercised less. The study results provided additional information on the database of the risk profile among Hong Kong cardiac patients. Relevance to clinical practice., Hypertension, obesity, physical inactivity, abnormal serum lipid levels and smoking are the modifiable risk factors for coronary heart diseases. As physical inactivity, overweight and hypercholesterolaemia were found in half of the studied subjects, the importance of risk factors control should be addressed to this group of patients. Nurses should be aware of their educator role to provide appropriate education to coronary heart disease patients with the focus on reducing and controlling of cardiac risk factors, which has been shown to be effective in reducing the progress of disease. [source] Ultrastructure of the gingiva in cardiac patients treated with or without calcium channel blockersJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003P. Bullon Abstract Objectives: In the last few years, several studies have suggested that periodontal diseases are related to the development of atherosclerosis and its complications. Our objective was to study the ultrastructural morphology of the gingiva from cardiac patients, some of whom were treated and some not with calcium channel blockers compared to a control group. Material and Methods: Fifty-five patients were studied and grouped in the following way: (a) healthy group (HG) (n=12) healthy patients with at least two pockets between 3 and 5 mm; (b) cardiac group (CG) (n=12) patients with cardiac disease untreated with calcium channel blockers; (c) diltiazem group (DG) (n=13) cardiac patients treated with diltiazem; (d) nifedipine group (NG) (n=18) cardiac patients treated with nifedipine. Results: Ultrastructural studies in the CG showed inflammatory cells, collagen fibers disruption and a more extended morphologically compromised fibroblast mitochondria. Morphometric studies in CG showed mitochondria that were impaired in number but increased in volume, suggesting metabolic cell suffering. In DG and NG, morphometric data were similar to HG. The presence of myofibroblasts and collagen neosynthesis was detected in DG and NG. Conclusions: Our data showed differences in the ultrastructure of the gingival fibroblasts between the studied groups; the DG and NG showed features that could be interpreted as an attempt to restore the cellular metabolic function. Zusammenfassung Ziele: In den letzten Jahren haben einige Studien darauf hingewiesen, dass parodontale Erkrankungen zur Entwicklung von Arteriosklerose und deren Komplikationen in Beziehung stehen. Unser Ziel war das Studium der gingivalen ultrastrukturellen Morphologie von herzkranken Patienten, von denen einige mit Kalzium-Kanal-Blockern und andere ohne diese Medikamente behandelt wurden, und mit Kontrollen zu vergleichen. Material und Methoden: 55 Patienten wurden untersucht und in eine der folgenden Gruppen eingeteilt: a, gesunde Gruppe (HG) (n=12): gesunde Patienten mit mindestens 2 Taschen zwischen 3 und 5 mm, b, herzkranke Gruppe (CG) (n=12): Patienten mit Herzerkrankung und nicht mit Kalzium-Kanal-Blockern behandelt, c, Diltiazem Gruppe (DG) (n=13): Herzkranke Patienten, die mit Diltiazem behandelt wurden, d, Nifedipin Gruppe (NG) (n=18): Herzkranke Patienten, die mit Nifedipin behandelt wurden. Ergebnisse: Die Ultrastruktur bei CG zeigte Entzündungszellen, zerrissene Kollagenfasern und stärker ausgedehnte morphologisch gefährdete Fibroblastenmitochondrien. Morphometrische Studien bei CG zeigten Mitochondrien, die in der Anzahl beeinträchtigt waren, aber im Volumen zugenommen hatten, was auf einen gestörten Zellstoffwechsel deutet. Bei DG und NG waren die morphometrischen Daten ähnlich zu HG. Die Präsenz von Myofibroblasten und Kollagensynthese wurde in DG und NG entdeckt. Schlussfolgerung: Unsere Daten zeigten Differenzen in der Ultrastruktur der gingivalen Fibroblasten zwischen den untersuchten Gruppen. DG und NG zeigten Eigenschaften, die als Versuch zur Restauration der zellulären Stoffwechselfunktion gedeutet werden könnten. Résumé Objectifs: Lors des dernières années, plusieurs études ont suggéré que les maladies parodontales sont liées au développement de l'athérosclérose et de ses conséquences. Notre objectif est d'étudier la morphologie ultrastructurale de la gencive de patients cardiaques traités et non traités par des bloqueurs des flux de calcium comparée à un groupe contrôle. Matériel et méthodes: 55 patients furent étudiés et groupés de la façon suivante: (a) groupe sain (HG) (n=12), patients sains avec au moins 2 poches entre 3 et 5 mm (b) groupe cardiaque(CG) (n=12) patients ayant une maladie cardiaque non traitée par des bloqueurs des flux de calcium (c) groupe diltiazem (DG) (n=13) patients cardiaques traits par diltiazem; (d) groupe nifedipine (NG) (n=18 patients cardiaques traits par nifedipine). Résultats: Des études ultrastructurale du groupe CG montraient des cellules inflammatoires, des interruptions des fibres de collagènes, et un nombre plus important de mitochondries des fibroblastes morphologiquement compromises. Les études morphométriques du groupe CG montraient des mitochondries altérées en nombre mais au volume augmenté ce qui suggérait une souffrance métabolique cellulaire. Dans les groupes DG et NG, les données morphométriques étaient similaires à celles du groupe HG. La présence de myofibroblastes et d'une néo-synthèse de collagène étaient détectées dans les groupes DG et NG. Conclusions: Nos données montrent des différences de l'ultrastructure des fibroblastes gingivaux entre les groupes étudiés, les groupes DG et NG présentant des caractéristiques qui peuvent être interprétées comme une tentative de restauration de la fonction métabolique cellulaire. [source] Tracheobronchography and angiocardiography of paediatric cardiac patients with airway disordersJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2002YF Cheung Objective: We report our experience in combining tracheobronchography and angiocardiography in the assessment of a selected cohort of paediatric cardiac patients with problematic airway disorders. Methodology: The clinical records of 11 patients who underwent 17 studies at a median age of 5.5 months (range 3 months to 10.8 years) were reviewed. Tracheobronchography and angiocardiography were performed under general anaesthesia using a non-ionic contrast agent. The findings were compared with those of flexible bronchoscopy and magnetic resonance imaging (MRI). Results: Seven patients had cardiac lesions associated with vascular anomalies potentially compressing the airway, while four had no identifiable aberrant or enlarged vessels. All examinations but one were performed without complications. Tracheobronchography demonstrated extrinsic vascular compression with secondary airway malacia in three (27%), intrinsic tracheobronchial stenosis in five (45%), and airway malacia in three patients (27%). Precise measurement of the airway calibre and real-time fluoroscopic monitoring facilitated transcatheter tracheobronchial interventions (six balloon dilations, three stent implantations) in four patients. In conjunction with angiocardiography, cine-tracheobronchography provided detailed information on the spatial relationship between vascular and airway structures in all patients; allowed dynamic assessment of airway malacia; and facilitated preoperative planning in six patients. In contrast, bronchoscopy failed to differentiate malacia from extrinsic compression in four patients (36%), while MRI, performed in six patients, was unsatisfactory in one due to a motion artefact and failed to diagnose airway malacia and extrinsic compression in three patients. Conclusions: Tracheobronchography is relatively safe in paediatric cardiac patients. Combined tracheobronchography and angiocardiography, a less operator-dependent imaging modality compared to bronchoscopy and MRI, delineated the airway and vascular anatomy in detail; facilitated preoperative planning; and permitted transcatheter tracheo-bronchial interventions. The dynamic capability of tracheobronchography supplements that of flexible bronchoscopy and MRI in the diagnosis of airway malacia. [source] Using guidelines for exercise in cardiac patientsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2006Associate Dean for Research), FAAN (Professor, Shirley M. Moore RN First page of article [source] The use of the nicotine inhaler in smoking cessationJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2006CCRN (Staff Nurse), Jenny Sigel Burkett RN Abstract Purpose: To raise awareness among nurse practitioners (NPs) about the nicotine inhaler by providing clinical and practical information about the use of the nicotine inhaler as a treatment option for smoking cessation. Data sources: This included data-based and review articles in the medical literature, tobacco use and dependence clinical practice guideline, and Medline and Cinahl search engines. Criteria for search keywords were "nicotine inhaler" and "nicotine replacement therapy." Initial search was done in December 2004. Conclusions: The nicotine inhaler has been tested as safe and efficacious in the treatment of tobacco cessation. Clinical trials show the nicotine inhaler to be useful alone or as an adjunct to other pharmacological therapies. Current national guidelines recommend that the nicotine inhaler be used in smoking cessation therapy. Implications for practice: The nicotine inhaler is appropriate for many different smokers, including certain types of cardiac patients. NPs can include the nicotine inhaler in a group of nicotine replacement therapies to ensure that smokers are successful in tobacco cessation. [source] Systolic 3D first-pass myocardial perfusion MRI: Comparison with diastolic imaging in healthy subjectsMAGNETIC RESONANCE IN MEDICINE, Issue 4 2010Taehoon Shin Abstract Three-dimensional (3D) first-pass myocardial perfusion imaging (MPI) is a promising alternative to conventional two-dimensional multislice MPI due to its contiguous spatial coverage that is beneficial for estimating the size of perfusion defects. Data acquisition at mid-diastole is a typical choice for 3D MPI yet is sensitive to arrhythmia and variations in R-R interval that are common in cardiac patients. End systole is the second longest quiescent cardiac phase and is known to be less sensitive to the R-R variability. Therefore, 3D MPI with systolic acquisition may be advantageous in patients with severe arrhythmia once it is proven to be comparable to diastolic MPI in subjects with negligible R-R variation. In this work, we demonstrate the feasibility of 3D MPI with systolic data acquisition in five healthy subjects. We performed 3D MPI experiments in which 3D perfusion data were acquired at both end-systole and mid-diastole of every R-R interval and analyzed the similarity between resulting time intensity curves (TIC) from the two data sets. The correlation between systolic and diastolic TICs was extremely high (mean = 0.9841; standard deviation = 0.0166), and there was a significant linear correlation between the two time intensity curve upslopes and peak enhancements (P < 0.001). Magn Reson Med 63:858,864, 2010. © 2010 Wiley-Liss, Inc. [source] Implantable Defibrillator Therapy in Naxos DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2000KOSTAS GATZOULIS Naxos disease is a unique form of right ventricular cardiomyopathy with a high prevalence of malignant ventricular arrhythmias, including sudden cardiac death. As a hereditary systemic disease confined to a small island, it has been closely studied over the last 15 years. The implantation of an automatic defibrillator provides an alternative form of antiarrhythmic management to improve life expectancy in these high risk cardiac patients. We present the first two Naxos disease patients with malignant ventricular arrhythmias who had defibrillator implantation. [source] Postbypass pulmonary artery pressure influences respiratory system compliance after ventricular septal defect closurePEDIATRIC ANESTHESIA, Issue 4 2000Muneyuki Takeuchi MD It is reported that surgical correction of left-to-right shunt improves respiratory function in paediatric cardiac patients. However, such correction sometimes does not result in an improvement of respiratory compliance. The purpose of this study was to look for factors determining changes in respiratory system compliance (Crs) in patients who underwent closure of ventricular septal defect (VSD closure). In a prospective study, 17 children (< 10 kg) who underwent VSD closure were enrolled. They were divided into two groups, according to postbypass mean pulmonary artery pressure (mPAP). The patients were allocated to Group C if mPAP was , 18 mmHg (n=12) and to Group PH if > 18 mmHg (n=5). We compared the ratio of postoperative Crs to preoperative Crs (Cpost/Cpre) between the groups. A multiple occlusion technique was used to measure Crs. The Cpost/Cpre in group C was larger than that in group PH (1.11 ± 0.17 vs. 0.81 ± 0.12, P < 0.01). There was a correlation between postbypass mPAP and Cpost/Cpre (rs=0.49, P < 0.05), but no correlation was noted between preoperative mPAP, Qp/Qs or Rp/Rs and Cpost/Cpre. We concluded that high postbypass mPAP was associated with a perioperative decrease in Crs after VSD closure. [source] Robotics in cardiac surgery: the Istanbul experienceTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2006Ertan Sagbas Abstract Background Robots are sensor-based tools capable of performing precise, accurate and versatile actions. Initially designed to spare humans from risky tasks, robots have progressed into revolutionary tools for surgeons. Tele-operated robots, such as the da VinciÔ (Intuitive Surgical, Mountain View, CA), have allowed cardiac procedures to start benefiting from robotics as an enhancement to traditional minimally invasive surgery. Methods The aim of this text was to discuss our experience with the da Vinci system during a 12 month period in which 61 cardiac patients were operated on. There were 59 coronary bypass patients (CABG) and two atrial septal defect (ASD) closures. Results Two patients (3.3%) had to be converted to median sternotomy because of pleural adhesions. There were no procedure- or device-related complications. Conclusion Our experience suggests that robotics can be integrated into routine cardiac surgical practice. Systematic training, team dedication and proper patient selection are important factors that determine the success of a robotic surgery programme. Copyright © 2006 John Wiley & Sons, Ltd. [source] Influence of Heavy Cigarette Smoking on Heart Rate Variability and Heart Rate Turbulence ParametersANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009Goksel Cagirci M.D. Background: Cigarette smoking increases the risk of cardiovascular events related with several mechanisms. The most suggested mechanism is increased activity of sympathetic nervous system. Heart rate variability (HRV) and heart rate turbulence (HRT) has been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. The goal of this study was to assess the effect of heavy cigarette smoking on cardiac autonomic function using HRV and HRT analyses. Methods: Heavy cigarette smoking was defined as more than 20 cigarettes smoked per day. Heavy cigarette smokers, 69 subjects and nonsmokers 74 subjects (control group) were enrolled in this study. HRV and HRT analyses [turbulence onset (TO) and turbulence slope (TS)] were assessed from 24-hour Holter recordings. Results: The values of TO were significantly higher in heavy cigarette smokers than control group (,1.150 ± 4.007 vs ,2.454 ± 2.796, P = 0.025, respectively), but values of TS were not statistically different between two groups (10.352 ± 7.670 vs 9.613 ± 7.245, P = 0.555, respectively). Also, the number of patients who had abnormal TO was significantly higher in heavy cigarette smokers than control group (23 vs 10, P = 0.006). TO was correlated with the number of cigarettes smoked per day (r = 0.235, P = 0.004). While LF and LF/HF ratio were significantly higher, standard deviation of all NN intervals (SDNN), standard deviation of the 5-minute mean RR intervals (SDANN), root mean square of successive differences (RMSSD), and high-frequency (HF) values were significantly lower in heavy smokers. While, there was significant correlation between TO and SDNN, SDANN, RMSSD, LF, and high frequency (HF), only HF was correlated with TS. Conclusion: Heavy cigarette smoking has negative effect on autonomic function. HRT is an appropriate noninvasive method to evaluate the effect of cigarette on autonomic function. Simultaneous abnormal HRT and HRV values may explain increased cardiovascular event risk in heavy cigarette smokers. [source] Beat-to-Beat QT Dynamics in Healthy SubjectsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2004Berit T. Jensen M.D. Background: Measures of QT dynamics express repolarization abnormalities that carry prognostic information, but the reproducibility of beat-to-beat QT dynamics has never been established. The QT interval is prolonged at night, but how the circadian rhythm and heart rate influence the dynamic QT measurements is still unsettled. The aims of the present study were: (1) to describe the reproducibility of beat-to-beat QT dynamics with respect to intrasubject, between-subject, and between-observer variability and (2) to describe the normal range, circadian variation, and heart rate dependence of QT dynamics. Methods: Ambulatory Holter recordings were performed three times on 20 healthy volunteers and were analyzed by two experienced cardiologists. Slope and intercept of the QT/RR regression, the variability of QT and R-R intervals expressed as the standard deviation, and the relation between QT and RR variability expressed as a variability ratio were measured among other QT dynamics. Results: The reproducibility of all QT dynamics was good. All QT dynamics showed circadian variation when calculated on an hourly basis. The day/night variation in slope could be explained by the differences in heart rate, whereas the day/night variation in intercept was heart rate independent. Conclusion: The present study shows that reliable automatic QT measurements could be performed, encouraging further evaluation of the clinical value of QT dynamics in risk stratification of cardiac patients. [source] DEVELOPING A CARDIAC REHABILITATION EDUCATION RESOURCE FOR RURAL HEALTH WORKERS IN QUEENSLAND: REVIEWING THE PROCESS AND OUTCOMESAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2002Elizabeth Parker ABSTRACT: The provision of cardiac rehabilitation services to people living in rural and remote areas is often limited to the nearest large hospital situated in urban coastal centres, leaving a gap in the rehabilitation of cardiac patients. This paper discusses the development, composition and the results of a process evaluation of a cardiac rehabilitation education resource for rural health workers. The development of the structure and content of the manual were informed by a review of current rehabilitation literature, the results of focus groups with 60 rural health workers in five Queensland rural centres, and survey results of 135 rural cardiac patients admitted to five Queensland hospitals. The draft manual was trialled by health workers in seven rural centres throughout Queensland by the National Heart Foundation (Queensland Division). The results of the process evaluation provided valuable feedback on the efficacy of the manual as an educational resource for rural health workers in the cardiac rehabilitation of their patients. Specific content in the educational resource was strengthened as a result of this evaluation. The limitations of the evaluation and suggestions for its improvement are also discussed. The paper highlights the importance of this level of evaluation in the development of health promotion education resources. [source] Predictors of survival in patients with systemic light-chain amyloidosis and cardiac involvement initially ineligible for stem cell transplantation and treated with oral melphalan and dexamethasoneBRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2008D. Lebovic Summary The treatment of systemic light-chain (AL) amyloidosis with symptomatic cardiac involvement at diagnosis remains a challenge. We report the results of 40 consecutive newly diagnosed AL cardiac patients who were not candidates for stem cell transplant and therefore received monthly oral melphalan and dexamethasone. Median survival was 10·5 months and baseline predictors of survival included gender, troponin I and interventricular septal thickness. The most significant predictor of survival was response to therapy. The haematological response rate was 58% (23/40) with 13% (5/40) complete responses; most responses were noted in <3 cycles. Achievement of a rapid response to therapy extends survival. [source] | ||||||||||||||||||||||