AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or s...AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or specific pain in patients with chronic stable heart failure. A standardized questionnaire (Edmonton Symptom Assessment System) was administered during a routine outpatient clinic visit. The severity of pain and other symptoms were assessed on a 10 point scale with 10 being the worst and 0 representing no symptoms. RESULTS: Sixty-two patients [age 56 ± 13 years, 51 males, 11 females, mean ejection fraction (EF) 33% ± 17%] completed the assessment. Thirty-two patients (52%) reported any pain of various character and location such as chest, back, abdomen or the extremities, with a mean pain score of 2.5 ± 3.1. Patients with an EF less than 40% (n = 45, 73%) reported higher pain scores than patients with an EF greater than 40% (n = 17, 27%), scores were 3.1 ± 3.3 vs 1.2 ± 1.9, P < 0.001. Most frequent symptoms were tiredness (in 75% of patients), decreased wellbeing (84%), shortness of breath (SOB, 76%), and drowsiness (70%). The most severe symptom was tiredness with a score of 4.0 ± 2.8, followed by decreased wellbeing (3.7 ± 2.7), SOB (3.6 ± 2.8), and drowsiness (2.8 ± 2.8). CONCLUSION: Pain appears to be prevalent and significantly affects quality of life in HF patients. Adequate pain assessment and management should be an integral part of chronic heart failure management.展开更多
BACKGROUND Heart transplantation is recommended for the treatment of patients with refractory heart failure.Chest pain after heart transplantation is usually considered noncardiac owing to the denervated heart.However...BACKGROUND Heart transplantation is recommended for the treatment of patients with refractory heart failure.Chest pain after heart transplantation is usually considered noncardiac owing to the denervated heart.However,data from case reports on tacrolimus-induced achalasia after heart transplantation are limited.We aimed to present a case of tacrolimus-induced achalasia that developed after heart tran-splantation,which was successfully relieved by laparoscopic Heller myotomy.CASE SUMMARY A 67-year-old man with a history of Type 2 diabetes mellitus,hyperlipidemia,and dilated cardiomyopathy had congestive heart failure following orthotopic heart transplantation with tacrolimus treatment 12 years ago.At the 10-year follow-up after the heart transplantation,the patient presented with persistent cough,dysphagia,heartburn,and retrosternal chest pain lasting for 2 wk.Upper endoscopy revealed no specific findings.Two years later,the patient experienced the same symptoms,including chest pain lasting for 4 wk.Esophagogram and manometry confirmed the presence of achalasia.Previous reports showed that discontinuing calcineurin inhibitor(CNI)treatment and endoscopic botulinum toxin injection could treat CNI-induced achalasia.Owing to the risk of rejection of the transplanted heart and considering the temporary benefits of botulinum toxin injection in achalasia,the patient underwent laparoscopic Heller myotomy.Dysphagia was relieved without complications.Eight months later,he had no signs of recurrence of the achalasia.CONCLUSION In transplant patients with chest pain and gastrointestinal symptoms, CNIinducedachalasia may be one of the differential diagnoses. Esophagogram/manometry is useful for diagnosis.展开更多
Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure ...Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain.Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group. The odds ratio of acute heart failure of positive group vs. negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31 patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.展开更多
Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure （CHF） patients. This study aimed to determine the clinical and biochemical charact...Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure （CHF） patients. This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain. Methods Sociodemographics, serum levels of creatinine, NT-proBNP, high-sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor （TNF）-α, interleukin （IL）-6 and IL-10, and two-dimensional echocardiographic left ventricular ejection fraction （LVEF） were determined in 305 patients with CHF. A questionnaire packet including the Brief Pain Inventory （BPI） and the Minnesota Living with Heart Failure Questionnaire （MLHFQ） was used to assess the degree of pain rated on a 0-10 scale and the quality of life （QOL）. A six-minute walking test was performed during routine clinic visits. Major adverse cardiac events （MACE） were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke at follow-up. Results Pain occurred in 25.6% of CHF patients, and was more common when the New York Heart Association （NYHA） functional class was worse. More patients with pain were female in gender, and had more co-morbidities, lower LVEF, and shorter distance during the 6-minute walking test. Despite similar serum levels of creatinine, N-terminal prohormone of brain natriuretic peptide （NT-proBNP）, IL-6 and IL-10, the TNF-a levels were higher and MLHFQ scores were greater in CHF patients with pain. At follow-up, CHF patients with moderate to severe pain （≥4 scale） had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke. Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.展开更多
目的探讨急性心肌梗死患者术后运动恐惧水平现状,并分析相关影响因素。方法选择医院2021年1月—2023年1月收治的106例急性心肌梗死患者为调查对象,采用一般资料调查表、心脏病患者运动恐惧量表(The Tampa Scale for Kinesiophobia Heart...目的探讨急性心肌梗死患者术后运动恐惧水平现状,并分析相关影响因素。方法选择医院2021年1月—2023年1月收治的106例急性心肌梗死患者为调查对象,采用一般资料调查表、心脏病患者运动恐惧量表(The Tampa Scale for Kinesiophobia Heart,TSK-SV Heart)进行现状调查,采用单因素分析和多元线性回归分析影响患者运动恐惧水平的相关因素。结果调查结果显示,急性心肌梗死患者运动恐惧总分为46.30±6.15分,其中各维度按照得分由高到低排序为运动回避14.52±2.83分、运动恐惧12.42±2.76分、功能紊乱9.71±1.57分、危险感知9.65±1.58分;单因素分析结果显示,年龄、职业、是否合并心衰、术后时间、主要照护者、有无合并症、疼痛评分均为影响急性心肌梗死术后患者运动恐惧的相关因素(P<0.05);多元线性回归分析显示,年龄、是否合并心衰、术后时间、主要照护者、疼痛评分为急性心肌梗死术后患者运动恐惧的影响因素(P<0.05)。结论急性心肌梗死患者术后运动恐惧水平得分高于临界值,高龄、合并心衰、术后时间短、无或主要照护者为护工、疼痛评分高的急性心肌梗死患者更易发生运动恐惧,提示临床医护人员应重视急性心肌梗死患者术后心理体验,并加强运动恐惧水平的评估,从以上因素出发制订针对性改善与管理策略,以提高急性心肌梗死患者自我效能,帮助其克服运动恐惧,从而提高康复效果。展开更多
文摘AIM: To evaluate the prevalence and severity of pain in patients with chronic stable heart failure (HF) in an outpatient clinic setting. METHODS: This is a cross-sectional study evaluating symptoms of generalized or specific pain in patients with chronic stable heart failure. A standardized questionnaire (Edmonton Symptom Assessment System) was administered during a routine outpatient clinic visit. The severity of pain and other symptoms were assessed on a 10 point scale with 10 being the worst and 0 representing no symptoms. RESULTS: Sixty-two patients [age 56 ± 13 years, 51 males, 11 females, mean ejection fraction (EF) 33% ± 17%] completed the assessment. Thirty-two patients (52%) reported any pain of various character and location such as chest, back, abdomen or the extremities, with a mean pain score of 2.5 ± 3.1. Patients with an EF less than 40% (n = 45, 73%) reported higher pain scores than patients with an EF greater than 40% (n = 17, 27%), scores were 3.1 ± 3.3 vs 1.2 ± 1.9, P < 0.001. Most frequent symptoms were tiredness (in 75% of patients), decreased wellbeing (84%), shortness of breath (SOB, 76%), and drowsiness (70%). The most severe symptom was tiredness with a score of 4.0 ± 2.8, followed by decreased wellbeing (3.7 ± 2.7), SOB (3.6 ± 2.8), and drowsiness (2.8 ± 2.8). CONCLUSION: Pain appears to be prevalent and significantly affects quality of life in HF patients. Adequate pain assessment and management should be an integral part of chronic heart failure management.
文摘BACKGROUND Heart transplantation is recommended for the treatment of patients with refractory heart failure.Chest pain after heart transplantation is usually considered noncardiac owing to the denervated heart.However,data from case reports on tacrolimus-induced achalasia after heart transplantation are limited.We aimed to present a case of tacrolimus-induced achalasia that developed after heart tran-splantation,which was successfully relieved by laparoscopic Heller myotomy.CASE SUMMARY A 67-year-old man with a history of Type 2 diabetes mellitus,hyperlipidemia,and dilated cardiomyopathy had congestive heart failure following orthotopic heart transplantation with tacrolimus treatment 12 years ago.At the 10-year follow-up after the heart transplantation,the patient presented with persistent cough,dysphagia,heartburn,and retrosternal chest pain lasting for 2 wk.Upper endoscopy revealed no specific findings.Two years later,the patient experienced the same symptoms,including chest pain lasting for 4 wk.Esophagogram and manometry confirmed the presence of achalasia.Previous reports showed that discontinuing calcineurin inhibitor(CNI)treatment and endoscopic botulinum toxin injection could treat CNI-induced achalasia.Owing to the risk of rejection of the transplanted heart and considering the temporary benefits of botulinum toxin injection in achalasia,the patient underwent laparoscopic Heller myotomy.Dysphagia was relieved without complications.Eight months later,he had no signs of recurrence of the achalasia.CONCLUSION In transplant patients with chest pain and gastrointestinal symptoms, CNIinducedachalasia may be one of the differential diagnoses. Esophagogram/manometry is useful for diagnosis.
文摘Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain.Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group. The odds ratio of acute heart failure of positive group vs. negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31 patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.
文摘Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure （CHF） patients. This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain. Methods Sociodemographics, serum levels of creatinine, NT-proBNP, high-sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor （TNF）-α, interleukin （IL）-6 and IL-10, and two-dimensional echocardiographic left ventricular ejection fraction （LVEF） were determined in 305 patients with CHF. A questionnaire packet including the Brief Pain Inventory （BPI） and the Minnesota Living with Heart Failure Questionnaire （MLHFQ） was used to assess the degree of pain rated on a 0-10 scale and the quality of life （QOL）. A six-minute walking test was performed during routine clinic visits. Major adverse cardiac events （MACE） were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke at follow-up. Results Pain occurred in 25.6% of CHF patients, and was more common when the New York Heart Association （NYHA） functional class was worse. More patients with pain were female in gender, and had more co-morbidities, lower LVEF, and shorter distance during the 6-minute walking test. Despite similar serum levels of creatinine, N-terminal prohormone of brain natriuretic peptide （NT-proBNP）, IL-6 and IL-10, the TNF-a levels were higher and MLHFQ scores were greater in CHF patients with pain. At follow-up, CHF patients with moderate to severe pain （≥4 scale） had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction, worsening heart failure or stroke. Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.
文摘目的探讨急性心肌梗死患者术后运动恐惧水平现状,并分析相关影响因素。方法选择医院2021年1月—2023年1月收治的106例急性心肌梗死患者为调查对象,采用一般资料调查表、心脏病患者运动恐惧量表(The Tampa Scale for Kinesiophobia Heart,TSK-SV Heart)进行现状调查,采用单因素分析和多元线性回归分析影响患者运动恐惧水平的相关因素。结果调查结果显示,急性心肌梗死患者运动恐惧总分为46.30±6.15分,其中各维度按照得分由高到低排序为运动回避14.52±2.83分、运动恐惧12.42±2.76分、功能紊乱9.71±1.57分、危险感知9.65±1.58分;单因素分析结果显示,年龄、职业、是否合并心衰、术后时间、主要照护者、有无合并症、疼痛评分均为影响急性心肌梗死术后患者运动恐惧的相关因素(P<0.05);多元线性回归分析显示,年龄、是否合并心衰、术后时间、主要照护者、疼痛评分为急性心肌梗死术后患者运动恐惧的影响因素(P<0.05)。结论急性心肌梗死患者术后运动恐惧水平得分高于临界值,高龄、合并心衰、术后时间短、无或主要照护者为护工、疼痛评分高的急性心肌梗死患者更易发生运动恐惧,提示临床医护人员应重视急性心肌梗死患者术后心理体验,并加强运动恐惧水平的评估,从以上因素出发制订针对性改善与管理策略,以提高急性心肌梗死患者自我效能,帮助其克服运动恐惧,从而提高康复效果。
