Potential markers for Coronary artery diseases

The incidence of Coronary artery disease (CAD) is mainly caused due to endothelial dysfunction or atherosclerosis and can be found in both developing and developed countries. Recent studies have shown that high homo cysteine levels are significantly associated with the CAD. Even low levels of vitamins like B12 and folic acid are associated with CAD. 

Despite best efforts, available therapies protect only 30-40% of individuals at risk, and no therapeutic cure is anticipated for those who currently suffer from the disease. The endothelium is a single layer of cells lining all blood vessels. It plays an important role in many physiological functions, including the control of blood cell trafficking, vasomotor tone, vessel permeability, and hemostatic balance. Endothelial cells produce a wide variety of substances in response to various physical and chemical stimuli, including vasodilator substances, and vasoconstrictor substances. Read more..............

Twelve Month Follow-Up Audit of Nigerian Hypertensives on Back Titration

The question of whether pharmacotherapy for systemic arterial hypertension should be life-long has continued to agitate the mind of care givers and patients alike. Whereas it is possible in some cases to reduce dose or discontinue drug(s) outright, relapse of high blood pressure is known to occur after some time. All the same, the attitude of step down or outright discontinuation of anti-hypertensive pharmacotherapy appears to be safe provided close monitoringcontinued. 

In an audit of hypertension care in a specialized care facility, the author observed that some patients remained controlled despite self-imposed drug holidays or physician initiated dose reduction following therapy induced hypotensive features. Some earlier workers had called for future studies to shed light on how long and intensively hypertensives could be treated before discontinuation of therapy can be embarked upon. Read more...................

Endofibrosis in an Endurance Athlete

A 35-year-old endurance athlete was referred for unexplained claudication-like complaints in his left lower limb. Elsewhere he was treated for functional compartment syndrome and operated for poplitealartery entrapment syndrome which proved unsuccessful. 

He complained of a painful and swollen left thigh at maximal exercise. Clinical investigation, ankle-to-brachial indices at rest and an additional magnetic resonance angiography were normal. 

An incremental treadmill test showed pathological ankle-to-brachial pressure measurement, duplex ultrasound imaging confirmed flow limitation and showed lesions of endofibrosis in the left external iliac artery. Surgery consisted of performing an endarterectomy of the external iliac artery with venous patching. Read more.................

What is Ventricular Tachycardia for an Automated External Defibrillator?

The present algorithm for the treatment of cardiac arrest relies on the paramount difference as to whether the underlying rhythm is shockable or not. Accordingly, only two options exist namely a rhythm in a cardiac arrest patient can be either shockable or not shockable. This exemplification was introduced in the 2000 Guidelines for Cardiac Arrest and Cardio Pulmonary Resuscitation (CPR) that overcame the previous classification which considered four main types of rhythms (asystole, pulseless electrical activity - PEA-, ventricular fibrillation and pulseless ventricular tachycardia) . The last two are those requiring prompt defibrillation.

Since then, this simplified algorithm became a standardized scheme which allowed a more schematic approach. For the treatment of ventricular tachycardia it is apparent that this rhythm may undergo an electrical defibrillation only in presence of a pulseless condition which cannot be detected by any kind of defibrillator. Indeed ventricular tachycardia may need prompt defibrillation in case of pulseless rhythms but may require synchronized electrical cardioversion when the patient is hemodynamically unstable but is not in cardiac arrest.  Read more.................

ACE Inhibitors or Sartans in the Treatment of Hypertension: A Needless Discussion?

Most patients who suffer from essential arterial hypertension must be treated with a antihypertensive preparation in order to adequately control blood pressure. According to current ESH (European Society of Hypertension)/ESC (European Society of Cardiology) guidelines, physician have at their disposal five main groups of antihypertensives (as also referred to as basic antihypertensives) for use in either monotherapy or in combination: diuretics, beta-blockers (BB), calcium ion channel blockers (CaI), angiotensin convertase (ACE) inhibitors and sartans.

Basic antihypertensives possess very similar efficacies in terms of blood pressure reduction. When used at full dose, the average drop of systolic blood pressure(SBP) is 9.1 mm Hg and diastolic blood pressure (DBP) 5.5 mm Hg. However, before the initiation of pharmacotherapy, other co-morbidities , contraindications and other factors must be taken into consideration. Considering the guidelines, initiation with renin-angiotensin-aldosterone system (RAAS) inhibitors i.e. ACE inhibitors or sartans is mostly recommended for a majority of co-morbidities. Alpha-1 blockers should only be considered in resistant hypertension, if no contraindication exists. Methyldopa (an alpha-2 agonist) should be preferred in hypertensive pregnant women. Read more............

Renal Denervation, ?Last Resort? or Alternative Therapy?

Arterial hypertension represents one of the main causes of morbidity and mortality among the population with high risk of cerebral strokes, coronary heart disease.It’sarbitrarily defined as “resistant” or “refractory” when recommended blood pressure targets are not achieved, despite changes in lifestyle and treatment with adequate doses of at least three antihypertensive drugs from different classes, including a diuretic.

In a recent clinical study, it’s proved a variable proportion (approximately 5-15%) of the general population of the patients with hypertension in treatment, which refer to the Centres of Excellence for the diagnosis and treatment hypertension, may be considered suffering from resistant hypertension. It‘s evident that 5-15% of patients with hypertension, Whereas 20% of the Western population is suffering from hypertension, is easy to understand the true dimension of the phenomenon. So the choice of treatment, comes to a crossroad. Should we insist with the combination of more than three medications, or choose the path of renal denervation? Read more...............

A NEW CCD IMAGING TECHNIQUE TO ASSESS CONTRACTILITY AND FUNCTIONING OF HEART

The ex vivo heart perfusion model is a well-accepted preparation, introduced more than a century ago. Nowadays, it is not so much used in the study of heart’s physiological principles, but in supplying corresponding physiological evidence to underlying molecular processes of ischemia, altered myocardial metabolism, new pharmaceutical agents, etc.,

Although it was named after Oscar Langendorff who demonstrated its use in the mammalian heart in 1895, the same model was well established by Elias Cyon in the frog heart as early as 1866 . The chronological reference tothe origin of the method is important not only for historical referencereasons, but also, and particularly so, for highlighting the tremendous efforts of the early physiologists to develop suitable recording methods in parallel. Although the continuous pressure monitoring was achieved quite early, almost simultaneously with the genesis of the model, the morphometric assessment of the beating heart, by means of volumetric changes, diastolic and systolic changes, was not possible until much later, during Starling’s era. Read more.............