The Canadian journal of cardiology
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To review the literature on anxiety, post-traumatic stress disorder (PTSD) and depression in patients with coronary artery disease (CAD), and to present an approach to diagnosis and treatment. ⋯ The present review offers practical recommendations on how to detect and assess anxiety, PTSD and depression in the cardiology or primary care setting. Treatment recommendations are provided, with a focus on pharmacotherapy for anxiety and depressive disorders in patients with CAD.
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Practice Guideline Guideline
The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part II - therapy.
To provide updated, evidence-based recommendations for the management of hypertension in adults. ⋯ All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
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Sudden death is usually the result of hemodynamically destabilizing ventricular tachycardia or ventricular fibrillation. Because the only definitive treatment for ventricular tachycardia/ventricular fibrillation is a direct current shock, and because that defibrillating shock must be given very quickly to be effective, the American Heart Association's "chain of survival" approach to persons with a cardiac arrest emphasizes early access to care, early cardiopulmonary resuscitation, early cardiac defibrillation and early advanced life support. ⋯ The automated external defibrillator enables life-saving defibrillation therapy to be provided to the cardiac arrest victim by nontraditional responders, such as the general public. The present review evaluates the current role of the automated external defibrillator in the ongoing struggle to prevent sudden cardiac death.
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The therapy for chronic obstructive lung disease (COPD) is largely symptomatic in nature, involving the use of bronchodilators and steroids, and the judicious use of antibiotics. None of these have been shown to have a consistent beneficial impact on outcome. Moreover, the outcome of patients with COPD is determined, to some extent, by the occurrence of cardiovascular events. ⋯ There appear to be direct links between lung injury and concomitant vascular injury by virtue of a systemic inflammatory state induced by lung inflammation. The present paper raises the possibility that the outcome of patients with COPD may be improved significantly through aggressive use of therapies known to prevent cardiovascular events. Moreover, angiotensin II is also a direct mediator of lung injury; interruption of this mechanism of injury might simultaneously prevent both cardiovascular and pulmonary morbidity and mortality in patients with chronic lung disease.
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Hypertrophic cardiomyopathy is a genetic disease that affects the cardiac sarcomere, resulting in myocardial hypertrophy and disarray. Affected patients have a predisposition for malignant ventricular tachyarrhythmias and, consequently, sudden cardiac death. With the availability of therapeutic measures that prevent sudden death, the identification of high-risk patients is now of greater importance. ⋯ For this purpose, amiodarone has been supplanted by the implantable cardioverter-defibrillator. Implantable cardioverter-defibrillator treatment appears to reduce the risk of sudden cardiac death in both primary and secondary prevention settings. Thus, tools are now available to identify and treat high-risk patients with hypertrophic cardiomyopathy.