Cardiology Patient Page Research Articles

Cardiology patient page. Platelets and cardiovascular disease.

Platelets are specialized disk-shaped cells in the blood stream that are involved in the formation of blood clots that play an important role in heart attacks, strokes, and peripheral vascular disease. In most people, the more than 200 million platelets in a milliliter of blood act as tiny building blocks to form the basis of a clot to stop bleeding from cuts or injuries. Platelets can detect a disruption in the lining of a blood vessel and react to build a wall to stop bleeding (Figure 1). Figure 1. Platelets form a platelet plug to stop bleeding from an injured blood vessel. In cardiovascular disease, abnormal clotting occurs that can result in heart attacks or stroke. Blood vessels injured by smoking, cholesterol, or high blood pressure develop cholesterol-rich build-ups (plaques) that line the blood vessel; these plaques can rupture and cause the platelets to form a clot. Even though no bleeding is occurring, platelets sense the plaque rupture and are confused, thinking that an injury has taken place that will cause bleeding. Instead of sealing the vessel to prevent bleeding as would occur with a cut, a clot forms in an intact blood vessel, causing a blockage of blood flow (Figure 2). Without …

Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke.

Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke.

Cardiology patient pages. Ambulatory electrocardiographic recording.

Cardiac rhythm abnormalities are common. Although many arrhythmias are not harmful, some can cause symptoms and be a signal for potential cardiac arrest or stroke. Thus, the detection and quantification of these arrhythmias are important, especially for patients who have structural heart disease caused by an event such as a prior heart attack. Arrhythmias are frequently limited in duration and occurrence and cannot be detected during physical examination and routine electrocardiography (ECG) because these procedures permit only a few seconds of observation. To diagnose arrhythmias and to assess their relationship to patient symptoms, or to assess the effectiveness of an intervention to suppress them, longer periods of ECG recording are required while the patient is pursuing his or her normal routine. In this paper, we review the techniques and the clinical situations in which ambulatory ECG recordings are indicated. The most commonly used method of extended ECG recording is a Holter monitor (named for its inventor, Norman Holter) that uses a conventional tape recorder or solid-state storage system for acquiring ECG information that is later processed and displayed for physician review (Figure). Traditionally, these recordings are carried out for 24 to 48 hours via leads placed on the chest to yield 2 or 3 channels of ECG data. The patient is instructed to keep a diary of symptoms and to note the time on the Holter clock when the symptoms occur for later correlation to ECG abnormalities. For example, if the patient has a dizzy spell or rapid heart rhythm during the recording, the physician can determine if an arrhythmia, either fast or slow, was or …

Cardiology patient page. Factor V Leiden.

You may have been tested for the condition known as factor V Leiden (pronounced factor five lye/-den) because you or someone in your family has had a blood clot in one of the deep veins of the body (also called deep vein thrombosis, or DVT) or a blood clot that traveled to the lung (also called a pulmonary embolism, or PE). Thrombophilia is the term used to describe the propensity of some people to form abnormal blood clots, and it may be either a condition that developed during your lifetime or that you inherited through your family. Some examples of situations in which thrombophilia develops include cancer, diabetes, obesity, and surgery. This Cardiology Patient Page will concentrate on factor V Leiden, the most common cause of inherited thrombophilia. The job of the blood is to deliver oxygen and nutrients to all the tissues of the body. Blood must remain in fluid form and does so through a series of complex biochemical reactions. Blood also has a mechanism to counteract to these reactions, if necessary, to stop bleeding in the case of injury to the blood vessels. This is the process of coagulation, which consists of enzymes forming a clot to plug leaks in blood vessels while other blood enzymes repair the damage. There is a delicate balance at work to ensure that there is enough — but not too much — clotting power in the blood. Not enough clotting power leads to bleeding problems, whereas too much clotting power (thrombophilia) can lead to the formation of dangerous blood clots. The state of this normal balance between bleeding and clotting differs from person to person, and many things can upset the balance (Figure). Factors that increase the risk of developing a DVT or PE. Factor V is a protein …

Cardiology patient pages. Cardiovascular disease in the diabetic patient.

Diabetes mellitus is a chronic metabolic disease characterized by a high blood sugar level. Over 17 million Americans are affected by the disease. About 10% of the US population over the age of 60 years has diabetes, with a disproportionately high number of black, Hispanic, Asian, and Native Americans affected. Furthermore, it is estimated that fully half of the population with diabetes remains undiagnosed. Diabetes may be caused by decreased insulin secretion, decreased insulin action, or both. Insulin, a hormone made in the pancreatic B-cell, assists in the transportation into cells and the use of sugar by cells throughout the body. Whether the body cannot make sufficient insulin or the insulin that is made does not function well in the body, the blood sugar level becomes elevated. Over time, increased blood sugars can damage both small and large blood vessels. In patients with type 1 diabetes, for unknown reasons, there is an autoimmune destruction of the insulin-secreting pancreatic B-cells, and insulin injections must be taken to survive. This type of diabetes represents less than 10% of all diabetes cases. In contrast, type 2 diabetes occurs in more than 90% of all patients with diabetes and is characterized by both insulin resistance and a relative reduction in insulin production. In type 2 diabetes, the treatment goal is to match the amount of insulin that the body can make to the amount that the body needs. There are many possible treatment options that the physician may initially prescribe; however, all regimens are based on healthy food choices and daily activity. If these lifestyle changes do not work, …

Treatment of Blood Clots

This Cardiology Patient Page will focus on medical treatment of blood clots that can cause critical illness by blocking the blood supply to the heart, brain, lungs, or legs. Blood clots that develop in the arteries can cause heart attack, stroke, and severe leg pain and difficulty walking. Blood clots in the veins or venous system can cause deep venous thrombosis (DVT) in the pelvic, leg, and upper extremity veins. When these DVTs break off and travel through the bloodstream to the heart and then to the lung blood vessels, they cause acute pulmonary embolism (PE).1 Treatment of arterial clots may include aspirin and clopidogrel (oral antiplatelet agents), intravenous antiplatelet agents, heparin (a blood thinner and anticoagulant), and clot busters (thrombolytic agents). In addition to medications, special interventional catheters may be used to remove or compress these arterial clots. ### Antiplatelet Agents Chewing an adult-strength aspirin tablet (325 mg) at the onset of heart attack symptoms can improve survival by 20%.2 Consequently, healthcare professional personnel administer aspirin to patients who may be experiencing a heart attack, thereby avoiding further injury to the heart muscle before the arrival of emergency medical services.3 The Clopidogrel in Unstable angina to prevent REcurrent events (CURE) Trial showed that clopidogrel, another oral antiplatelet agent, given in conjunction with aspirin, reduces the risk of death even further in the setting of certain types of heart attacks.4 Intravenous antiplatelet agents may also be used to treat impending or evolving heart attacks in combination with aspirin and clopidogrel. This triple antiplatelet therapy is highly potent and predisposes the patient to bruising. However, major bleeding complications, such as stomach ulcer …

Cardiology patient page. Diseases of the veins.

Three sets of vessels comprise the circulatory system: arteries, lymphatics, and veins. Arteries bring oxygen-carrying blood from the heart to the tissues. In the normal course of blood circulation, small amounts of fluid and protein leak from arteries and veins. Lymphatic vessels bring this protein-rich fluid back into the circulation. The third type of blood vessel is the vein. Veins bring oxygen-depleted blood from the organs and tissues to the heart and lungs, where it is re-oxygenated. Blood return to the heart tends to be passive and is enabled by muscle contraction in the arms and legs. Because the venous system is a low pressure one, the telltale complaints and physical signs of venous disease on which your physician relies for diagnosis are often subtle and sometimes require further testing. Diseases of the veins fall into two broad categories: blockage from a blood clot (thrombosis) and inadequate venous drainage (insufficiency). The legs are the most common location for blood clot formation (thrombus) in the venous system. Today, the most commonly encountered causes for blood clots include cancer, prolonged immobility, an inherited tendency for blood clotting, pregnancy, and contraceptive use. ### Superficial Thrombophlebitis Blood clots may develop in the veins that lie either just under the skin or deep within the limb. In the skin-deep (superficial) veins, a blood clot commonly appears as a red streak along the course of an affected vein and is often accompanied by inflammation (phlebitis). The vein may feel warm and tender and may be swollen. This combination of clot and inflammation, known as superficial thrombophlebitis, commonly occurs in the setting of varicose veins. Cancer may be the cause for development of many episodes of superficial blood clots; this is known as Trousseau’s syndrome. Superficial thrombophlebitis is typically more annoying than dangerous because the likelihood that the clot(s) will …

Cardiology patient page. Restenosis: repeat narrowing of a coronary artery: prevention and treatment.

A Angioplasty is a safe and effective way to unblock coronary arteries. During this procedure, a catheter is inserted into the groin or arm of the patient and guided forward through the aorta and into the coronary arteries of the heart. There, blocked arteries can be opened with a balloon positioned at the tip of the catheter. Initially, angioplasty was performed only with balloon catheters, but technical advances have been made and improved patient outcome has been achieved with the placement of small metallic spring-like devices called stents (Figure 1) at the site of the blockage. The implanted stent serves as a scaffold that keeps the artery open. Figure 1. Size of an expanded coronary stent in relation to a dime. The stent is 18 mm in length and 3.5 mm in diameter. Angioplasty and stenting techniques are widely used around the world and provide an alternative option to medical therapy and bypass surgery for improving blood flow to the heart muscle. There are, however, limitations associated with angioplasty and stenting, one of which is called “restenosis.” Restenosis occurs when the treated vessel becomes blocked again. It usually occurs within 6 months after the initial procedure. …

The Long-QT Syndrome

The heart is a pump that is stimulated by electrical signals to beat between about 50 to 180 times per minute, depending upon the individual’s level of activity and emotional state. The heart itself is made up of millions of cells that generate repetitive sequences of electrical discharges (referred to in medicine as depolarization) and recharging (repolarization) that produce each heart beat. Electrical activity of the heart cells is produced by the synchronized movement of sodium, potassium, and calcium ions into and out of the cells. ### Long-QT Syndrome Long-QT Syndrome (LQTS) is a disorder of the electrical activity of the heart that can result in blackouts (fainting, also known as syncope) or sudden cardiac death. It occurs infrequently and is caused either by an inherited genetic condition (inherited form of LQTS) or by some prescription medications (acquired form of LQTS). QT refers to the interval on ECG between the beginning of the heart’s electrical discharge through its electrical recovery (see Figure 1). Figure 1 illustrates how the QT interval is measured on the ECG. Schematic diagram of the electrical activity of one heart beat recorded by an ECG. The electrical discharge (depolarization) of the ventricle is represented by the QRS complex, with the T wave reflecting electrical recovery (repolarization). The QT is the time interval from the beginning of the QRS complex to the end of the T wave, and is generally less than 0.44 seconds in normal individuals. In subjects with the long-QT syndrome, the QT is usually longer than 0.44 seconds. Delayed electrical recovery within the heart can be associated with very dangerous, rapid, and chaotic heart rhythms (medical terms for these abnormal heart rhythms are …

Clinical Cardiology: Physician Update and The Cardiology Patient Page

Clinical Cardiology: Physician Update and The Cardiology Patient Page

New Sections in Circulation

HomeCirculationVol. 104, No. 23New Sections in Circulation Free AccessAnnouncementPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAnnouncementPDF/EPUBNew Sections in Circulation James T. Willerson, MD James T. WillersonJames T. Willerson Search for more papers by this author Originally published4 Dec 2001https://doi.org/10.1161/circ.104.23.2755-aCirculation. 2001;104:2755The first Section is entitled “Clinical Cardiology: Physician Update,” and was introduced in the May 29, 2001, issue. This Section will be clinically oriented and directed to the practicing physician. Articles will be contributed by experts recognized for their ability to describe in practical terms the implementation of therapeutic advances and the optimal use of new diagnostic modalities.The second Section is entitled “The Cardiology Patient Page,” and was introduced in the June 26, 2001, issue. This Section will include articles on various topics in cardiovascular medicine that will be written in lay language by healthcare professionals and is designed to provide descriptions of critical concepts in cardiovascular diagnosis, testing methods, and therapeutics.Dr Elliott Antman has been named as Section Editor for the new initiative. The new Sections are being launched first in the electronic version of Circulation to fulfill the goal of shortening the time between reporting of scientific advances and translation into patient care.Cardiovascular NewsImages in Cardiovascular Medicine“Petrified” Right Ventricle in Long-Standing Naxos Arrhythmogenic Right Ventricular CardiomyopathyCristina Basso, MD, PhD; Adalena Tsatsopoulou, MD; Gaetano Thiene, MD; Aris Anastasakis, MD; Marialuisa Valente, MD; Nikos Protonotarios, MD (Circulation. 2001; 104:e132–e133Google Scholar.) Previous Back to top Next FiguresReferencesRelatedDetails December 4, 2001Vol 104, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.104.23.2755-a Originally publishedDecember 4, 2001 PDF download Advertisement

New Sections in Circulation

HomeCirculationVol. 104, No. 21New Sections in Circulation Free AccessAnnouncementPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAnnouncementPDF/EPUBNew Sections in Circulation James T. Willerson, MD James T. WillersonJames T. Willerson Search for more papers by this author Originally published20 Nov 2001https://doi.org/10.1161/circ.104.21.2505-aCirculation. 2001;104:2505The first Section is entitled “Clinical Cardiology: Physician Update,” and was introduced in the May 29, 2001, issue. This Section will be clinically oriented and directed to the practicing physician. Articles will be contributed by experts recognized for their ability to describe in practical terms the implementation of therapeutic advances and the optimal use of new diagnostic modalities.The second Section is entitled “The Cardiology Patient Page,” and was introduced in the June 26, 2001, issue. This Section will include articles on various topics in cardiovascular medicine that will be written in lay language by healthcare professionals and is designed to provide descriptions of critical concepts in cardiovascular diagnosis, testing methods, and therapeutics.Dr Elliott Antman has been named as Section Editor for the new initiative. The new Sections are being launched first in the electronic version of Circulation to fulfill the goal of shortening the time between reporting of scientific advances and translation into patient care. Previous Back to top Next FiguresReferencesRelatedDetails November 20, 2001Vol 104, Issue 21 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.104.21.2505-a Originally publishedNovember 20, 2001 PDF download Advertisement

New Sections in Circulation

HomeCirculationVol. 104, No. 20New Sections in Circulation Free AccessAnnouncementPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAnnouncementPDF/EPUBNew Sections in Circulation James T. Willerson, MD James T. WillersonJames T. Willerson Search for more papers by this author Originally published13 Nov 2001https://doi.org/10.1161/circ.104.20.2385-aCirculation. 2001;104:2385The first Section is entitled “Clinical Cardiology: Physician Update,” and was introduced in the May 29, 2001, issue. This Section will be clinically oriented and directed to the practicing physician. Articles will be contributed by experts recognized for their ability to describe in practical terms the implementation of therapeutic advances and the optimal use of new diagnostic modalities.The second Section is entitled “The Cardiology Patient Page,” and was introduced in the June 26, 2001, issue. This Section will include articles on various topics in cardiovascular medicine that will be written in lay language by healthcare professionals and is designed to provide descriptions of critical concepts in cardiovascular diagnosis, testing methods, and therapeutics.Dr Elliott Antman has been named as Section Editor for the new initiative. The new Sections are being launched first in the electronic version of Circulation to fulfill the goal of shortening the time between reporting of scientific advances and translation into patient care. Previous Back to top Next FiguresReferencesRelatedDetails November 13, 2001Vol 104, Issue 20 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.104.20.2385-a Originally publishedNovember 13, 2001 PDF download Advertisement