The Canadian journal of cardiology
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Cardiologists' expertise in managing traumatic heart disease will be increasingly sought as the incidence of both firearm and motor vehicle accidents soars. Knowledge of mechanisms of injury, as well as appropriate use of diagnostic tools, will aid in rapid recognition of complications related to cardiac injury.
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The diagnosis of myocardial necrosis in patients with chronic renal failure is often difficult because biochemical markers of cardiac damage such as creatine kinase MB (CKMB) and cardiac troponin T (cTnT) may be spuriously elevated. Recent small studies also report unexplained elevations in cardiac troponin I (cTnI) in chronic renal failure patients undergoing hemodialysis. The relative incidence of elevated cardiac troponins in this population and their relationship to clinical events remain unknown. ⋯ cTnT is commonly elevated in patients with chronic renal failure even in the absence of acute coronary syndromes. cTnT may be an important independent prognostic marker in patients on hemodialysis for chronic renal failure. While less common, elevations of cTnI are more frequent than CKMB elevations. The basis of these cardiac troponin elevations is unclear. These findings may represent, in part, a subclinical myocardial injury, an inflammatory response to chronic renal failure or a chronically volume overloaded state.
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Review
Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature.
Herbal medicines are popular but health care professionals often feel uncertain about their risks. This article summarizes recent evidence regarding the serious or potentially serious cardiovascular adverse effects of herbal medicines. Five electronic literature databases were searched. ⋯ Because of the anecdotal nature of the evidence, it is impossible to estimate the incidence of adverse effects. In conclusion, herbal medicinal products are regularly associated with serious cardiovascular adverse events but the size of this problem cannot be estimated at present. Vigilance and research seem to be the best way forward.
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Medical, social and economic costs of congestive heart failure (CHF) continue to rise. There exists a 'care gap' between what the optimal care populations with CHF should receive and actually do receive. Central to the goal to develop effective strategies against the 'care gap' is accurate measurement of the CHF burden. Administrative data are limited in detail and accuracy and clinical databases suffer from limited size. Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a province-wide population-based disease management study with access to all patient health data including outcomes. ⋯ The burden of disease for CHF in Nova Scotia is large and affects an elderly population with multiple comorbidities. Adverse outcomes such as death, rehospitalization and admission to a chronic care facility are common. Measurement of the 'care gap' requires consideration of these factors and of elderly and female patients regardless of left ventricular function. Successful strategies will likely be multidisciplinary in scope with a focus toward improving access to care.
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To determine the adequacy of the discharge summary in reporting important investigative results and future management plans in patients hospitalized and discharged with a diagnosis of heart failure. ⋯ Substantial inadequacies exist in communicating to the community physician, at the time of discharge from an acute care teaching hospital, valuable patient management information of patients with heart failure. This may have implications for continuity of care and subsequent clinical outcomes.