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Coronary Heart Disease Risk Factors
Published in Mark C Houston, The Truth About Heart Disease, 2023
Smoking causes the following problems:Inflammation, oxidative stress, and increased high-sensitivity C-reactive protein (HS-CRP).The platelets in your blood clump together more easily and are more likely to form clots. Clumping platelets can then block your coronary arteries and cause an MI.Precipitate spasms occur in your coronary arteries, which reduces the blood flow to your heart and induces anginal chest pain, shortness of breath, or MI.Triggers irregular heartbeats (arrhythmias).Lowers HDL cholesterol, which is protects against CHD.Reduces the amount of oxygen that can be carried by red blood cells to all tissues and to the heart.Produces constriction of the systemic arteries and causes hypertension.Increases fibrinogen in the blood, making it thicker and more likely to clot.
Democratic gestures
Published in Alan Bleakley, Medical Education, Politics and Social Justice, 2020
The thinking has now strayed far from “patient-centredness” (that is a de-territorializing tactic affording power to the patient) to reintroduce the boundary that denotes “medical territory: do not enter”. Thus: Tachycardia is a condition that makes your heart beat more than 100 times per minute: “your heart is racing”.A pulmonary infiltrate, observed on the chest X-ray, is a substance denser than air, such as pus, blood or protein, which lingers within the lungs: “your lungs are clogged, stopping you from breathing easily”.Ground-glass opacity is a metaphor or resemblance used to shortcut to an instant diagnosis (technically referring to an area of increased attenuation in the lung with preserved bronchial and vascular markings). While it is a non-specific sign with a wide aetiology including infection, chronic interstitial disease and acute alveolar disease, here it is linked with a COVID-19 infection. The patient could readily identify with this resemblance (“ground glass” as opaque) giving him (in the example above) a strong image for relating to his illness. Resemblances, often used as rapid diagnosis in medicine (“strawberry tongue” – possibly scarlet fever) can readily be related to by a layperson.
Some particular challenges
Published in Roger Neighbour, Jamie Hynes, Helen Stokes-Lampard, Consulting in a Nutshell, 2020
Roger Neighbour, Jamie Hynes, Helen Stokes-Lampard
Another example: Patient‘The nurse did a heart tracing, and she said something about an irregular heartbeat.’You‘Yes, it's good that she spotted it. The ECG tracing shows you have a condition called atrial fibrillation, which makes your heart beat erratically. It's not too serious in itself, but it could cause complications if we don't take precautions to prevent them.’
Effect of menopausal symptom treatment options on palpitations: a systematic review
Published in Climacteric, 2022
Y. Sheng, J. S. Carpenter, C. D. Elomba, J. S. Alwine, M. Yue, C. X. Chen, J. E. Tisdale
When compared to the vast literature available on vasomotor symptoms, palpitations during the menopause transition appear to be seldomly studied. Palpitations are reported by 20–42% of perimenopausal women and 16–54% of postmenopausal women as sensations of skipped, missed or exaggerated heartbeats [13]. Distress from palpitations during the menopause transition has been associated with more severe insomnia, worse depressive symptoms and poorer menopausal quality of life [14]. Whether palpitations are associated with electrocardiogram (ECG) abnormalities is not fully known. In the Tromsø population-based study (n = 22,815), the sensation of palpitations (e.g. sudden changes in heart rate or rhythm) in the past year was associated with greater risk of developing incident, ECG-verified, atrial fibrillation (odds ratiowomen = 1.62 [95% confidence interval 1.29–2.02]) when controlling for other known risk factors [15]. Atrial fibrillation is one of several arrhythmias that increases morbidity and mortality [16]. Similar to untreated vasomotor symptoms, untreated palpitations may increase direct care costs and lead to poorer health, lower work productivity and greater health-care utilization and costs [17–20].
Clinical electrophysiology of the aging heart
Published in Expert Review of Cardiovascular Therapy, 2022
Kyle Murray, Muizz Wahid, Kannayiram Alagiakrishnan, Janek Senaratne
Palpitations are a heightened or uncomfortable awareness of heartbeat and are a common reason for elderly patients to present to a clinic or hospital [34]. Palpitations are divided into cardiac and noncardiac causes. Noncardiac causes are further subclassified into psychosomatic, medical illness, and pharmacologic mediated. Cardiac causes are secondary to arrhythmias (e.g. tachyarrhythmia, bradyarrhythmia, and extrasystoles) and structural heart disease (e.g. valvular disease, heart failure, and hypertrophic cardiomyopathy). In adults presenting to emergency with palpitations, 47% of cases are a cardiac cause [35]. Patients who are elderly, male, have irregular palpitations, palpitations lasting >5 minutes, and history of coronary artery disease (CAD) have a high likelihood of a cardiac cause [24].
How can we manage the cardiac toxicity of immune checkpoint inhibitors?
Published in Expert Opinion on Drug Safety, 2021
Remo Poto, Giancarlo Marone, Flora Pirozzi, Maria Rosaria Galdiero, Alessandra Cuomo, Luigi Formisano, Roberto Bianco, Carminia Maria Della Corte, Floriana Morgillo, Stefania Napolitano, Teresa Troiani, Carlo G Tocchetti, Valentina Mercurio, Gilda Varricchi
Signs and symptoms of cardiac toxicity due to ICIs are variable depending on the type of cardiac involvement and the degree of disease. Cardiac toxicity may present with non-organ specific symptoms such as fatigue, weakness, muscle pain, and syncope. However, typical cardiac symptoms such as palpitations, shortness of breath, chest pain, pulmonary or lower extremity edema, an irregular heartbeat can occur at any time of treatment [32]. Moslehi and collaborators presented the most comprehensive clinical characterization of cardiovascular irAEs associated with ICIs through analysis of reported side effects from the WHO pharmacovigilance database [55]. The authors identified ICIs’ associations not only with myocarditis, but also with pericardial diseases and vasculitis. They also reported that cardiovascular irAEs can occur early after ICI administration, even after the first dose. Autoimmune myocarditis had an early onset (median 30 days) and was associated with high mortality (50%). Importantly, cardiac IRAEs could be associated with other IRAEs [35].