The American journal of cardiology
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The renin-angiotensin system is a key regulatory system that is activated in many forms of cardiovascular disease. It is well established that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are important therapeutic agents in the treatment of hypertension, myocardial infarction, and congestive heart failure. ⋯ The possible role of renin-angiotensin system activation in arrhythmogenesis suggests that ACE inhibitors and ARBs may be important therapeutic agents in the prevention and treatment of arrhythmias. This review summarizes the current evidence for the use of ARBs in the treatment of atrial and ventricular arrhythmias.
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Analyses of aortic specimens obtained from patients with tetralogy of Fallot (TOF) revealed elastic fiber fragmentation. This study sought to determine the prevalence of aortic root dilation and aortic regurgitation (AR) in children after TOF repair and tested the hypothesis that aortic elastic properties are altered and related to aortic root dilation in these patients. Aortic dimensions, adjusted for body surface area and expressed as z scores, and AR were assessed echocardiographically in 67 children 8.3 +/- 5.6 years after TOF repair. ⋯ Aortic stiffness was correlated positively, whereas aortic strain and distensibility were correlated negatively, with the aortic root z scores at all levels. In conclusion, this study shows a high prevalence of aortic root dilation in children after the repair of TOF. Aortic stiffening occurred in these patients and may play a role in progressive aortic root dilation.
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Among 4,333 patients who were triaged in the emergency department (ED) over a 1-year period in 2003 because of acute chest pain, 1,747 (40%) were stratified as "low risk" on the basis of a Thrombolysis In Myocardial Infarction (TIMI) risk score of 0 to 2. Results showed that, during ED stay, TIMI risk score increased to > or =3 in 63% of patients and that such patients were more likely to be diabetic, hypertensive, hyperlipidemic, and smokers, and to have had previous myocardial infarction or revascularization. ⋯ Changes in TIMI risk score are more common in patients with multiple risk factors and/or previous diagnosis of coronary artery disease. Serial, frequent assessments of TIMI score during the ED observation period are mandatory, particularly in these subsets of patients.
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Ten patients underwent rescue percutaneous coronary intervention for myocardial infarction or ischemia soon after coronary artery bypass grafting, and 6 received drug-eluting stents (DESs). Outcomes were limited primarily by bleeding events. There was 1 episode of DES thrombosis after antiplatelet therapy was discontinued due to gastrointestinal hemorrhage. Rescue percutaneous coronary intervention is a feasible approach to reestablish coronary perfusion in the perioperative period, but DESs should be used only after appropriate risk stratification for potential bleeding complications that may require the withdrawal of antiplatelet therapy.
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Extreme obesity is known to be associated with left ventricular (LV) systolic dysfunction. The relation of lesser degrees of obesity and LV systolic function is controversial. This study assessed the relation between body mass index (BMI; weight in kilograms divided by height in meters squared) and the LV ejection fraction (EF) and volumes in 1,806 subjects with normal technetium-99m sestamibi myocardial perfusion imaging results. ⋯ BMI remained an independent predictor of greater end-diastolic volumes in men and women (p <0.01) even after accounting for co-morbidities. In conclusion, mild obesity was associated with LV dilatation, but the LVEF was preserved even with severe obesity. Weight control may be recommended to reduce the incidence of obesity-related co-morbidities and their impact on adverse LV remodeling.