Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years. Every year in the United States more than 700,000 patients arriv... Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years. Every year in the United States more than 700,000 patients arrive at the emergency room with ST-segment elevation myocardial infarction(STEMI). About 60 percent of hospital admissions for AMI are of people older than 65 years. Their in-hospital, 1-month,and 1-year mortality is high. 1 In this article, we will provide a review on clinical trials that guide the management of STelevation myocardial infarction of the elderly patients.……展开更多
The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute pha... The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……展开更多
The benefits of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) beyond blood pressure reduction have been proven through many large studies (HOPE, LIFE) in high risk CVD patie... The benefits of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) beyond blood pressure reduction have been proven through many large studies (HOPE, LIFE) in high risk CVD patients;1 post hoc studies have shown reductions in new onset type 2 diabetes mellitus (DM). ……展开更多
Apolipoprotein E (Apo E) is quite a fascinating lipoprotein. As reported by Zou et al. 1 in this issue of the Journal of Geriatric Cardiology, Apo E has three isoforms,ε2, ε3, and ε4, differing from each other ... Apolipoprotein E (Apo E) is quite a fascinating lipoprotein. As reported by Zou et al. 1 in this issue of the Journal of Geriatric Cardiology, Apo E has three isoforms,ε2, ε3, and ε4, differing from each other by the polymorphisms found in the amino acid residues at sites 112 and 158. Apo E and its three isoforms, with ε3 being the most common, is like a Pandora's box of sorts, where upon investigation, interesting correlations to some very prominent modem diseases have been found. For example, there was evidence that the presence of one ε4 allele in their Apo E gene increased the risk for type-2Alzheimer's disease and two ε4 alleles would increase further this risk. Also intriguing is the subject of this paper by Zou et al.: the relationship between Apo E isoform ε2 and the presence of coronary artery disease (CAD).……展开更多
In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thromboti... In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.……展开更多
BACKGROUND Studies have suggested that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to inflammation.determine morbidity and mortality associated with AF in hospitalized patients with RD.MET...BACKGROUND Studies have suggested that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to inflammation.determine morbidity and mortality associated with AF in hospitalized patients with RD.METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF.A subgroup analysis was performed comparing outcomes of AF among different RD.RESULTS The prevalence of AF was 23.9%among all patients with RD(n=3949203).Among the RD subgroup,the prevalence of AF was highest in polymyalgia rheumatica(33.2%),gout(30.2%),and pseudogout(27.1%).After adjusting for comorbidities,the odds of having AF were increased with gout(1.25),vasculitis(1.19),polymyalgia rheumatica(1.15),dermatopolymyositis(1.14),psoriatic arthropathy(1.12),lupus(1.09),rheumatoid arthritis(1.05)and pseudogout(1.04).In contrast,enteropathic arthropathy(0.44),scleroderma(0.96),ankylosing spondylitis(0.96),and Sjorgen’s syndrome(0.94)had a decreased association of AF.The mortality,length of stay,and hospitalization costs were higher in patients with RD having AF vs without AF.Among the RD subgroup,the highest mortality was found with scleroderma(4.8%),followed by vasculitis(4%)and dermatopolymyositis(3.5%).CONCLUSION A highest association of AF was found with gout followed by vasculitis,and polymyalgia rheumatica when compared to other RD.Mortality was two-fold higher in patients with RD with AF.展开更多
BACKGROUND Classic electrocardiographic manifestations of hyperkalemia starting with peaked symmetrical T-waves are widely recognized in daily clinical practice but little evidence is documented how quickly it can evo...BACKGROUND Classic electrocardiographic manifestations of hyperkalemia starting with peaked symmetrical T-waves are widely recognized in daily clinical practice but little evidence is documented how quickly it can evolve in real-time.CASE SUMMARY An elderly diabetic and hypertensive male presented with acute renal failure and rhabdomyolysis.He experienced cardiac arrest with moderate hyperkalemia despite medical treatment and hemodialysis.Telemetry changes were retrospectively studied and found to have significant rhythm changes that occurred just less than 10 minutes prior to the cardiac arrest.CONCLUSION In hyperkalemia,telemetry rhythm can change instantaneously in a significant way.Rapidly rising potassium could be life threatening and may require more than medical treatment.展开更多
文摘 Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years. Every year in the United States more than 700,000 patients arrive at the emergency room with ST-segment elevation myocardial infarction(STEMI). About 60 percent of hospital admissions for AMI are of people older than 65 years. Their in-hospital, 1-month,and 1-year mortality is high. 1 In this article, we will provide a review on clinical trials that guide the management of STelevation myocardial infarction of the elderly patients.……
文摘 The systemic response to tissue injury, regardless of cause is characterized by a cytokine-mediated alteration in the hepatic synthesis of a number of different plasma proteins,known collectively as 'acute phase reactants'. These proteins include C-reactive protein, serum amyloid A protein, alphal glycoprotein, ceruloplasmin, alpha macroglobulins, complement components (C1-C4, factor B, C9, C11), alpha1antitrypsin, alpha1 antichymotrypsin, fibrinogen, prothrombin,factor Ⅷ, plasminogen, haptoglobin, ferritin, immunoglobulins and lipoproteins. The initiation of the acute phase response is linked to the production of hormone-like polypeptide mediators now called cytokines, namedly, interleukin 1(IL-1),tumor necrosis factor, interferon gamma, interleukin 6 (IL-6),leukemia inhibitory factor, ciliary neurotropic factor, oncostatin M, and interleukin 11 (IL- 11).……
文摘 The benefits of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) beyond blood pressure reduction have been proven through many large studies (HOPE, LIFE) in high risk CVD patients;1 post hoc studies have shown reductions in new onset type 2 diabetes mellitus (DM). ……
文摘 Apolipoprotein E (Apo E) is quite a fascinating lipoprotein. As reported by Zou et al. 1 in this issue of the Journal of Geriatric Cardiology, Apo E has three isoforms,ε2, ε3, and ε4, differing from each other by the polymorphisms found in the amino acid residues at sites 112 and 158. Apo E and its three isoforms, with ε3 being the most common, is like a Pandora's box of sorts, where upon investigation, interesting correlations to some very prominent modem diseases have been found. For example, there was evidence that the presence of one ε4 allele in their Apo E gene increased the risk for type-2Alzheimer's disease and two ε4 alleles would increase further this risk. Also intriguing is the subject of this paper by Zou et al.: the relationship between Apo E isoform ε2 and the presence of coronary artery disease (CAD).……
文摘 In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.……
文摘BACKGROUND Studies have suggested that atrial fibrillation(AF)in patients with rheumatic diseases(RD)may be due to inflammation.determine morbidity and mortality associated with AF in hospitalized patients with RD.METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF.A subgroup analysis was performed comparing outcomes of AF among different RD.RESULTS The prevalence of AF was 23.9%among all patients with RD(n=3949203).Among the RD subgroup,the prevalence of AF was highest in polymyalgia rheumatica(33.2%),gout(30.2%),and pseudogout(27.1%).After adjusting for comorbidities,the odds of having AF were increased with gout(1.25),vasculitis(1.19),polymyalgia rheumatica(1.15),dermatopolymyositis(1.14),psoriatic arthropathy(1.12),lupus(1.09),rheumatoid arthritis(1.05)and pseudogout(1.04).In contrast,enteropathic arthropathy(0.44),scleroderma(0.96),ankylosing spondylitis(0.96),and Sjorgen’s syndrome(0.94)had a decreased association of AF.The mortality,length of stay,and hospitalization costs were higher in patients with RD having AF vs without AF.Among the RD subgroup,the highest mortality was found with scleroderma(4.8%),followed by vasculitis(4%)and dermatopolymyositis(3.5%).CONCLUSION A highest association of AF was found with gout followed by vasculitis,and polymyalgia rheumatica when compared to other RD.Mortality was two-fold higher in patients with RD with AF.
文摘BACKGROUND Classic electrocardiographic manifestations of hyperkalemia starting with peaked symmetrical T-waves are widely recognized in daily clinical practice but little evidence is documented how quickly it can evolve in real-time.CASE SUMMARY An elderly diabetic and hypertensive male presented with acute renal failure and rhabdomyolysis.He experienced cardiac arrest with moderate hyperkalemia despite medical treatment and hemodialysis.Telemetry changes were retrospectively studied and found to have significant rhythm changes that occurred just less than 10 minutes prior to the cardiac arrest.CONCLUSION In hyperkalemia,telemetry rhythm can change instantaneously in a significant way.Rapidly rising potassium could be life threatening and may require more than medical treatment.
