China
Africa
Explore chapters and articles related to this topic
Metabolic Cardiology
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
D-ribose is a building block of adenosine triphosphate (ATP) – the energy of life. Almost 40 years ago, I first started my patients, and myself, on the vitamin-like/antioxidant/nutrient called CoQ10 (ubiquinone). CoQ10 is effective on almost everything cardiac: blood pressure stabilization, oxygen utilization, angina, valvular problems, arrhythmias and chronic HF. One of the first articles that caught my attention on CoQ10 was an investigation in the Annals of Thoracic Surgery in 198229 where Japanese researchers showed that patients came off heart-lung bypass machines more easily post-operatively when CoQ10 was taken for the month before heart surgery. It reduced pulmonary wedge pressure and increased cardiac index.29 As an antioxidant and membrane stabilizer, it helped to prevent the oxidation of LDL. I even tracked some heart transplant candidates who were able to come off the transplant list if they maintained the higher CoQ10 blood levels that I monitored for them.
Cardiac Damage from Left Ventricular Hypertrophy to Heart Failure
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Enrico Agabiti Rosei, Maria Lorenza Muiesan, Cesare Cuspidi
Subendocardial ischemia, typically seen in patients with LVH even in the presence of normal epicardial arteries, can deteriorate diastolic filling. Conversely, since most of the coronary flow occurs in diastole, alterations of myocardial relaxation or compliance may affect blood supply. Diastolic abnormalities may be observed early in the natural history of hypertension and may also be demonstrated in normotensive subjects with parental hypertension (82,83). A few studies, using different techniques, showed that diastolic LV performance significantly influences exercise capacity in hypertensive patients with LVH (84–87). Brogan et al. (75) and Fagard et al. (88), who defined diastolic dysfunction on the basis of left ventricular end diastolic pressure or pulmonary wedge pressure, respectively, found an association between diastolic dysfunction and subsequent incidence of heart failure or cardiovascular events.
The Microcirculation and Clinical Disease
Published in John H. Barker, Gary L. Anderson, Michael D. Menger, Clinically Applied Microcirculation Research, 2019
John E. Tooke, Laurence H. Smaje
More subtle or low-grade chronic derangement is usually only detectable by investigation, and the majority of these tests are clinical research tools rather than methods used in current clinical practice. Organ-specific methodologies in current use are referred to in the relevant chapters and examples only are summarized here. An estimation of pulmonary capillary pressure may be obtained from the pulmonary “wedge” pressure, obtained by advancing a catheter into the pulmonary artery until it wedges in a distal artery. An estimate of alveolar permeability may be obtained by measuring the transfer factor — the disappearance of carbon monoxide from inhaled air, a freely diffusible molecule with avidity for hemoglobin. Access to filtrate (urine) makes renal microvascular function more accessible to clinical investigation and techniques exist for estimating the clearance of various solutes, renal plasma flow, and glomerular filtration rates.34 The selectivity of the glomerular barrier can be assessed both in terms of charge and molecular size using appropriate molecular probes. The retina is one of the few vascular beds that is routinely observed in clinical practice. The development of vitreous fluorophotometry provides the means to quantitative retinal vessel barrier function35 and laser scanning ophthalmoscopy enables detailed analysis of microvascular perfusion in the macular region.36
Levosimendan: mechanistic insight and its diverse future aspects in cardiac care
Published in Acta Cardiologica, 2023
Md Sayeed Akhtar, Md Quamrul Hassan, Aisha Siddiqui, Sirajudeen S. Alavudeen, Obaid Afzal, Abdulmalik S.A Altamimi, Syed Obaidur Rahman, Mallika Khurana, Mohamed Jawed Ahsan, Arun Kumar Sharma, Fauzia Tabassum
Lack of evidence and inconsistencies between different LEVO-HF related studies conducted around the globe have major concerns in clinical use. LEVO exerts its cardiac cardiodynamic effects by three key processes: Inotropic impact, improved endothelial functions, and cardiac protection. The CO and cardiac stroke volume has been well improved in decompensated HF. Concurrent to the reduction in incident of HF, pulmonary wedge pressure, SVR, and pulmonary vascular resistance has been also improved by LEVO administration. Uniquely, it directly maintains myocardial functioning devoid of any sympathetic activities. Cardiac pleiotropy of LEVO added additional benefits in preventing occurrence of cardiomyopathy followed by AHF. LEVO can be also beneficial in both non-cardiac surgery as well as renal complications associated with HF. Surprisingly, its active metabolites greatly possess similar cardio dynamic properties and thus efficacy of LEVO remains preserved throughout many days. However, in contrast to this evidence, LEVO also not exhibited advantage over dobutamine in clinical practice as discussed above. Keeping these facts in mind, overseeing more satisfactory meta-analysis is mandatory to find any conclusive clarity and applicability about LEVO in HF issues.
Overview of Impella and mechanical devices in cardiogenic shock
Published in Expert Review of Medical Devices, 2018
Hymie Habib Chera, Menachem Nagar, Nai-Lun Chang, Carlos Morales-Mangual, George Dous, Jonathan D. Marmur, Muhammad Ihsan, Paul Madaj, Yitzhak Rosen
CS is one of the major clinical presentations of acute heart failure. The characteristic features of CS include a pulmonary wedge pressure (PWP) which is more than 18 mmHg, cardiac index less than 2.2 L/min/m2 [3], and persistent organ hypoperfusion causing oliguria and cold, clammy extremities. Non-ischemic etiologies of LV or right ventricular (RV) dysfunction such as myopericarditis, acute decompensation secondary to chronic systolic dysfunction, acute and progressive valvular disease, and Takotsubo cardiomyopathy remain common and contribute to the progression of CS [4].
An update on current and emerging treatments for pulmonary arterial hypertension in childhood and adolescence
Published in Expert Review of Respiratory Medicine, 2019
Julie Wacker, Robert Weintraub, Maurice Beghetti
The definition of PH is a mean pulmonary artery pressure (mPAP) ≥25 mmHg assessed by a right heart catheterization [5]. In addition, in order to be classified as PAH, pulmonary wedge pressure should be lower than 15 mmHg, and indexed pulmonary vascular resistance (PVRi) should be elevated (>3 Woods Units (WU)·m2).